Acta neurochirurgica
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Acta neurochirurgica · Aug 2010
Review Meta AnalysisSurgery for extratemporal nonlesional epilepsy in adults: an outcome meta-analysis.
To better evaluate surgery for extratemporal lobe epilepsy (ETLE) in adults, we conducted a meta-analysis of previous studies that analyzed postoperative seizure outcomes for ETLE. ⋯ This meta-analysis confirms the findings of other centers: ETLE surgical outcomes are less desirable than those for temporal lobe epilepsy. None of the factors studied in adults showed significant association with outcome. Contrary to some reports, shortening the duration of epilepsy by pursuing surgery as early as possible also does not appear to improve outcomes. The creation of standard protocols among epilepsy centers is needed to allow for a detailed evaluation of outcomes across different centers and, ultimately, to better assess the factors associated with improved outcomes.
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Acta neurochirurgica · May 2010
Review Case ReportsOperative intervention for delayed symptomatic radionecrotic masses developing following stereotactic radiosurgery for cerebral arteriovenous malformations--case analysis and literature review.
We report two cases of operative intervention that was beneficial in the treatment of delayed symptomatic radionecrotic masses that had developed following stereotactic radiosurgery (SRS) using the gamma knife (GK) for the treatment of cerebral arteriovenous malformations (AVM). ⋯ We recommend early surgical intervention for such delayed symptomatic radionecrotic masses that do not resolve following non-operative management. We also recommend caution in interpretation of SPECT scan results when attempting to differentiate radionecrosis from neoplasia.
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Acta neurochirurgica · May 2010
Review Case Reports Historical ArticlePituitary apoplexy: an overview of 186 cases published during the last century.
Pituitary apoplexy is a rare and life-threatening complication occurring in 0.6-10.5% of all cases of pituitary adenomas. Although the association between pituitary apoplexy and visual dysfunction has been recognized for a long time, the optimal management of this problem still remains controversial. The purpose of this overview was to present the surgical experience by analyzing the literature on the management of pituitary apoplexy for better treatment of these cases. ⋯ Based on an overview of 186 cases of apoplectic pituitary adenoma presenting with monocular or binocular blindness, we highlight the importance of correct diagnosis and an early, but not necessarily emergency, surgery within the first week of admission to optimize visual outcome of such patients. The illustrative case further exemplifies the value of close interaction between members of the management team for optimal outcome.
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Acta neurochirurgica · Feb 2010
Review Case ReportsPostoperative intracranial seeding of craniopharyngiomas--report of three cases and review of the literature.
Seeding of craniopharyngioma has been rarely reported. We present three cases that ectopically recurred with seeding along the surgical route and CSF spaces. ⋯ Although craniopharyngiomas exhibit a benign histopathological pattern, cerebrospinal fluid seeding along the surgical route or along the CSF pathways has been observed. Ectopic recurrence of craniopharyngioma suggests that meticulous protection of the whole surgical field and careful handling of the tumor during the operation are required. It should be emphasized that long-term follow-up is mandatory, even in patients undergoing a total removal.
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Acta neurochirurgica · Jan 2010
ReviewUpdate on protein biomarkers in traumatic brain injury with emphasis on clinical use in adults and pediatrics.
This review summarizes protein biomarkers in mild and severe traumatic brain injury in adults and children and presents a strategy for conducting rationally designed clinical studies on biomarkers in head trauma. ⋯ We conclude that only S-100B in severe traumatic brain injury has consistently demonstrated the ability to predict injury and outcome in adults. The number of studies with protein degradation products is insufficient especially in the pediatric care. Cohort studies with well-defined end points and further neuroproteomic search for biomarkers in mild injury should be triggered. After critically reviewing the study designs, we found that large homogenous patient populations, consistent injury, and outcome measures prospectively determined cutoff values, and a combined use of different predictors should be considered in future studies.