Acta neurochirurgica
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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.
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Acta neurochirurgica · Jan 2010
Case ReportsLong-term control of clival chordoma with initial aggressive surgical resection and gamma knife radiosurgery for recurrence.
Chordomas are locally destructive tumors with high rates of recurrence, and therapeutic strategies remain controversial. This study analyzed long-term outcomes for clival chordomas after initial aggressive surgical resection and gamma knife radiosurgery for recurrence and investigated clinical factors predicting recurrence. ⋯ Long-term control of clival chordomas was achieved. Recurrent tumors were controlled with gamma knife radiosurgery, since lesions were localized and small after initial aggressive resection. The MIB-1 labeling index can provide important information for predicting tumor recurrence.
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Acta neurochirurgica · Jan 2010
Case ReportsIatrogenic tension pneumothorax resulting in pneumocephalus after insertion of a ventriculoperitoneal shunt: an unusual complication.
We report the case of an iatrogenic tension pneumothorax related to the placement of a ventriculoperitoneal shunt, followed by pneumocephalus. The patient was pending cranioplasty and shunt placement after decompressive craniectomy for acute subdural hematoma and posttraumatic hydrocephalus. Facilitating the severe and potential life-threatening complication was a severe obesity of the patient as well as incorrect surgical technique.
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Acta neurochirurgica · Jan 2010
Determinants of postoperative visual recovery in suprasellar meningiomas.
Suprasellar meningiomas usually present with visual deterioration, including decreased visual acuity and/or visual field defects. Suprasellar meningiomas have a close relationship with the optic apparatus, arteries of the anterior circulation, pituitary stalk and hypothalamus, which makes safe surgical resection a challenge especially with dissection around an already compromised optic apparatus. In this report 21 patients operated on for a suprasellar meningioma over a 4-year period are reviewed. Postoperative outcome and visual recovery are evaluated, including analysis of its determinants. ⋯ The extent and duration of visual symptoms, size of the tumor and vascular adherence were prognostic factors affecting visual recovery after microsurgical resection of suprasellar meningiomas.
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Acta neurochirurgica · Jan 2010
Case ReportsImage-guided cranial osteoma resection and bioceramic porous hydroxyapatite custom-made reconstruction in a one-step surgical procedure. Technical notes and illustrative case.
Removal of a large cranial tumour and reconstruction of the consequent bone defect in the same surgical setting is an ordinary procedure. A custom-made hydroxyapatite ceramic reconstruction of a cranial bone defect is a modern option that currently needs a preoperative stage of studying the bone defect and designing the implant. Consequently, if a reconstructive hydroxyapatite-based procedure after a cranial tumour resection is the aim, a two-stage surgery is necessary. The authors investigated the possibility of performing this procedure in a one-step surgery by the use of a neuronavigation system. ⋯ Surgical removal of a cranial bone tumour and optimal reconstruction with a custom-made hydroxyapatite ceramic implant is an appealing procedure that can be carried out in a one-step surgery by means of an intraoperative image-guidance system.