Acta neurochirurgica
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Acta neurochirurgica · Jun 2017
Case ReportsFluorescence-guided resection of extracranial soft tissue tumour infiltration in atypical meningioma.
The exact role of 5-aminolevulinic acid (5-ALA) fluorescence-guided meningioma resection is as yet unclear. Although most of the meningiomas show positive fluorescence, the influence on outcome, fluorescence heterogeneity within the tumour, the correlation between fluorescence and the proliferation rate, as well as different quantitative measurements are a matter of debate. Positive fluorescence in bone infiltrative meningiomas is well described, whereas little data exist about 5-ALA fluorescence within soft tissue infiltration. ⋯ Preoperative imaging showed tumour infiltration throughout the calvaria. 5-ALA fluorescence of the tumour as well as bone, periost and temporal muscle helped to perform a gross total resection. Histological examination showed an atypical meningioma (WHO Grade II) and gave proof of tumour infiltration of the bone and temporal muscle. With the aid of 5-ALA fluorescence, a gross total resection could be performed.
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Acta neurochirurgica · Jun 2017
Review Comparative StudyStereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review.
Repeated controlled studies have revealed that stereotactic radiosurgery is better than microsurgery for patients with vestibular schwannoma (VS) <3 cm in need of intervention. In this systematic review we aimed to compare results from single-fraction stereotactic radiosurgery (SRS) to fractionated stereotactic radiotherapy (FSRT) for patients with VS. ⋯ SRS and FSRT are both noninvasive treatment alternatives for patients with VS with low rates of treatment failure in need of rescue therapy. In this selection of patients, the progression-free survival rates were on the order of 92-100% for both treatment options. There is a lack of high-quality studies comparing radiation therapy alternatives for patients with VS. Finally, 19 articles reported long-term tumor control after SRS, while only 2 articles reported long-term FSRT results, making effect estimates more uncertain for FSRT.
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Acta neurochirurgica · Jun 2017
Increased risk of critical CBF levels in SAH patients with actual CPP below calculated optimal CPP.
Cerebral pressure autoregulation can be quantified with the pressure reactivity index (PRx), based on the correlation between blood pressure and intracranial pressure. Using PRx optimal cerebral perfusion pressure (CPPopt) can be calculated, i.e., the level of CPP where autoregulation functions best. The relation between cerebral blood flow (CBF) and CPPopt has not been examined. The objective was to assess to which extent CPPopt can be calculated in SAH patients and to investigate CPPopt in relation to CBF. ⋯ Calculation of CPPopt is possible in a majority of patients with severe SAH. Actual CPP below CPPopt is associated with low CBF.
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Acta neurochirurgica · Jun 2017
Case ReportsSpinal extradural arteriovenous fistula with intradural drainage: three surgical cases with long-term follow-up.
Spinal extradural arteriovenous fistulas (SEDAVF) with intradural drainage are uncommon vascular lesions that cause venous congestive myelopathy. We present three SEDAVF with intradural drainage treated with surgical disconnection of the intradural drainage via a single level laminectomy, followed by transarterial embolization (TAE) with Onyx if spontaneous thrombosis of the extradural fistula did not occur spontaneously. All patients improved their neurological condition and no congestive myelopathy recurrence was noted after mean follow-up of 84 months. We believe that SEDAVF with intradural drainage constitute a specific entity that should be included in the classifications of spinal arteriovenous malformations.
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Acta neurochirurgica · Jun 2017
Simultaneous combination of electromagnetic navigation with visual evoked potential in endoscopic transsphenoidal surgery: clinical experience and technical considerations.
The combination of electromagnetic navigation with continuous monitoring techniques allows for the best available anatomic and real-time functional intraoperative monitoring. Methodological aspects and technical adaptations for this combination of methods and the results from 19 patients with tumors in the pituitary region are reported. ⋯ We performed eTSS for pituitary tumor by simultaneously using electromagnetic navigation and VEP. The optimal distance between the emitter and tracker minimizes VEP monitoring noise and allows accurate electromagnetic navigation.