Acta neurochirurgica
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Intracranial arterial dolichoectasia is a condition in which arteries demonstrate an increase in length and diameter, with the vertebrobasilar system being the most commonly affected segment. Because the criteria for and degree of vertebrobasilar dolichoectasia are usually established on three-dimensional time-of-flight MR angiography, we presented the results of an anatomic study of vertebrobasilar dolichoectasia cadaveric specimens. ⋯ We noted a predisposition of males older than 40 years to arterial dolichoectasia in the vertebrobasilar system, independently from population group, as well as its asymptomatic appearance, independently from the presence of atherosclerotic plaques.
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Acta neurochirurgica · Aug 2012
The effect of centralization of caseload for primary brain tumor surgeries: trends from 2001-2007.
Improved patient outcomes have been associated with high-caseload hospitals for a multitude of conditions. This study analyzed adult patients undergoing surgical resection or biopsy of primary brain tumors. The aim of this study is two-fold: (1) to evaluate whether the trend towards centralization of primary brain tumor care in the US has continued during the period of between 2001 and 2007, and (2) to analyze volume-outcome effects. ⋯ Neurosurgical caseload at the nation's high volume craniotomy centers has continued to rise disproportionately, while low-caseload centers have seen a decrease in overall surgical volume. Over the time period between 2001 and 2007 there was a trend towards improved in-hospital mortality, LOS and discharge disposition for all hospitals; however, the trend is convincingly favorable for high-caseload hospitals.
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Acta neurochirurgica · Aug 2012
Predictors of work status and quality of life 9-13 years after aneurysmal subarachnoid hemorrahage.
Aneurysmal subarachnoid hemorrhage (SAH) causes long-term psychosocial impairments even in patients who regain functional independence. Little is known about predictors of these impairments. We studied how early clinical data and neuropsychological results predict work status and health-related quality of life (HRQoL) 9-13 years after SAH. ⋯ Questionnaire ratings of patients' psychosocial impairments 1 year after SAH give important information for the long-term prediction of their work status and HRQoL. In the long run, patients' unemployment becomes strongly associated with higher age, while their performance of usual activities can be predicted with learning and memory results.
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Acta neurochirurgica · Aug 2012
Surgical treatment of symptomatic cerebral cavernous malformations in eloquent brain regions.
Despite the increased risk of hemorrhage and deteriorating neurological function of once-bled cerebral cavernous malformations (CM), the management of eloquently located CMs remains controversial. ⋯ Despite the high postoperative transient morbidity, the majority improved profoundly during follow-ups. Compared with natural history, surgical treatment should be considered for all eloquent symptomatic CMs. Dorsal brainstem location and poor preoperative neurological status are associated with an increased postoperative morbidity.
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Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a time-honored, crucial procedure employed in the management of well-selected patients with cerebrovascular ischemic disease, particularly moyamoya. In addition, its application to complex cerebral aneurysms and neoplasms requiring vessel sacrifice for complete resection continues to stand the test of time. ⋯ With careful attention to the surgical nuances of STA-MCA bypass, this indispensable procedure is a hemisphere-preserving technique that can be performed with high patency and low morbidity rates.