World Neurosurg
-
To review a series of patients who underwent Gamma Knife surgery (GKS) to identify prognostic factors for local growth control and survival. ⋯ GKS for melanoma brain metastasis provides a high rate of local tumor control. Survival is longest for well-functioning patients with absence of extracranial metastases or with an intracerebral total tumor volume less than 5 cc.
-
To describe an approach to the analysis of deep brain stimulation (DBS) of the subthalamic nucleus (STN) using a hidden semi-Markov model (HsMM) and early results of the analysis of microelectrode recordings for STN DBS. ⋯ Further clinical work must be done; however, based on these data, HsMMs may be best suited to computer-assisted anatomic delineation for DBS.
-
Stereotactic radiosurgery (SRS) is a form of radiation therapy that delivers a focused, highly conformal dose of radiation to a single volume, while minimizing damage to the adjacent nervous tissue. The efficacy of SRS has been examined in the treatment of patients diagnosed with brain metastases due to the fact that it is capable of targeting any region in the brain and can irradiate multiple tumors in the same treatment setting in a noninvasive fashion. ⋯ SRS can be an advantageous course of treatment in specific patient groups when utilized alone, after surgery, with WBRT, or in combination with either or both of the treatment modalities. Although treatment approaches have been refined, many questions remain unanswered and further clinical evidence is needed to guide physicians in their future treatment decisions regarding treating patients in specific clinical scenarios.
-
Randomized Controlled Trial Comparative Study
A randomized controlled trial comparing the outcome of burr-hole irrigation with and without drainage in the treatment of chronic subdural hematoma: a preliminary report.
Burr-hole is the most frequently used neurosurgical treatment for chronic subdural hematoma (CSDH). Few data can be found in the literature confirming the impact of using drainage after evacuation and irrigation of the cavity containing CSDH on the outcome of the patients. It is not clear whether installing such a drainage system would reduce the recurrence rate. ⋯ Type of surgical technique does not seem to be a main variable improving the outcome of such patients and may act as a confounding factor. Age, neurological status, and comorbidities seem to have more significant impact upon the surgical outcome.
-
Direct surgery for complex internal carotid artery (ICA) aneurysms can be difficult. In certain situations, sacrificing the parent artery is a unique way to obliterate the aneurysm and extracranial-to-intracranial (EC-IC) bypass is indispensable to prevent postoperative cerebral ischemia. This article discusses the indications for direct ICA occlusion, and the strategies, techniques, and outcomes in a series of patients treated for complex ICA aneurysms in a single institution. ⋯ Balloon occlusion test combined with computed tomographic perfusion can be an efficient way to evaluate the compromised cerebrovascular reserve in patients with complex ICA aneurysms after ICA occlusion. In conjunction with EC-IC bypass, ICA proximal occlusion or trapping can be an effective treatment strategy.