Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Oct 2014
Prediction of ventriculoperitoneal shunt placement based on type of failure during external ventricular drain wean.
There are multiple etiologies for failure while weaning an external ventricular drain (EVD) after subarachnoid hemorrhage (SAH), but there is little data on the relationship between etiology of wean failure and ventriculoperitoneal shunt (VPS) placement. ⋯ There is a significant association between wean failure due to clinical changes and requirement for VPS placement after SAH.
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Clin Neurol Neurosurg · Oct 2014
Surgical outcomes after posterior fossa decompression with and without duraplasty in Chiari malformation-I.
Chiari malformation-I (CM) is one of the most controversial entities in the contemporary neurosurgical literature. Posterior fossa decompression (PFD) is the preferred treatment for CM with and without syringomyelia. A variety of surgical techniques for PFD have been advocated in the literature. The aim of this study was to evaluate our results of surgically treated patients for CM-I with and without syringomyelia; using extradural dura-splitting and intradural intraarachnoid techniques. ⋯ The present study reports favorable surgical outcomes with extra-dural decompression of the posterior fossa in patients CM-I without syringomyelia. For patients with syringomyelia and history of prior PFD, intradural intra-arachnoid decompression is required. The prior history of decompression was associated with unfavorable outcomes. The use of duraplasty was associated with longer duration of hospital stay and higher complication rate. Further large cohort prospective study is needed to provide any recommendation on the indication of intra or extradural decompression for a given CM-I patient.
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Clin Neurol Neurosurg · Oct 2014
Management and outcomes of malignant posterior reversible encephalopathy syndrome.
Recognition of severe forms of posterior reversible encephalopathy syndrome (PRES) has improved. Management of these patients remains challenging, particularly in patients with the combination of edema and hemorrhage. ⋯ In contrast to historical reports of high mortality rates (16-29%) for severe and hemorrhagic PRES variants, we had no fatalities and observed favorable functional outcomes with intracranial pressure monitoring and craniectomy for malignant PRES cases who fail medical ICP management.
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Clin Neurol Neurosurg · Oct 2014
Characteristics of midline suprasellar meningiomas based on their origin and growth pattern.
The aim of the present study was to elucidate clinical and prognostic characteristics of the midline suprasellar meningiomas based on their origin and growth pattern. ⋯ The group A meningioma had the high rate of complete resection and favorable RFS. Groups B and C2 involve optic pathway and optic canal predominately. The group C1 DSM was an independent predictor of subtotal resection, postoperative visual field and h-p axis impairment. The subtotal resection was an independent predictor of the recurrence.
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Clin Neurol Neurosurg · Oct 2014
Relevance of gamma knife radiosurgery alone for the treatment of non-small cell lung cancer brain metastases.
Stereotactic radiosurgery (SRS) followed by close follow-up is becoming a popular strategy for the management of brain metastases as cancer patients live longer and late adverse effects of whole brain radiotherapy (WBRT) are increasingly reported. The authors report their experience in consecutively treated patients with limited brain metastases from non-small cell lung cancer (NSCLC), who underwent SRS alone followed by a close follow-up. ⋯ In patients with limited brain metastases from NSCLC, SRS is an effective treatment associated with high local control rate with low morbidity. When performed in isolation, close follow-up is mandatory and radiosurgery can be renewed as salvage treatment for distant brain progression, limiting the use of WBRT.