Acta neurochirurgica
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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 meningioma consistency: A study in 243 consecutive cases.
Meningioma is a common neoplasm primarily arising in the central nervous system. Its consistency is considered to be one of the critical prognostic factors for determining surgical resectability. The present study endeavored to investigate predictive factors associated with the tumor consistency. ⋯ Signal intensity on T2WI and FLAIR image can be used for insinuating meningioma consistency. Presurgical prediction of the consistency is highly valuable in operative planning, particularly in arduous cases.
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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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Acta neurochirurgica · Jul 2012
ReviewWhat is a reasonable surgical procedure for spinal extradural arachnoid cysts: is cyst removal mandatory? Eight consecutive cases and a review of the literature.
Spinal epidural arachnoid cysts (EAC) are rare and may present with myelopathy, which can be completely curable with surgery. The majority of investigators believe that the repairment of dural defect is important to treat EAC. However, the necessity of excising EACs remains controversial. The purpose of this study was to find a reasonable surgical technique for treatment of EACs after considering the clinical outcome, recurrence, and complications. ⋯ Total excision of EACs may have little benefit in terms of cyst recurrence and clinical outcome. The procedure for EAC resection carries a risk of complications such as kyphosis. If EAC resection is performed, we suggest that a tailored short-level laminotomy be used to allow for the repair of dural defects. Particularly in patients with small EAC, a partial hemilaminectomy with dural defect repair may be a possible method to reduce complications.
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Acta neurochirurgica · Jul 2012
ReviewVasospasm after spontaneous angiographically negative subarachnoid hemorrhage.
Vasospasm, delayed infarcts and clinical deterioration due to delayed cerebral ischemia (CD-DCI) following digital subtraction angiography (DSA)-negative, spontaneous subarachnoid hemorrhage (SAH) are infrequently and inconsistently described in the literature. ⋯ Although they are seen less frequently in patients with DSA-negative spontaneous SAH, vasospasm, delayed infarcts and CD-DCI do occur and may require endovascular therapy. Risk factors include a diffuse hemorrhage pattern and higher Hunt-Hess grade.