Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Mar 2016
Cost-effectiveness analysis of CTA and LP for evaluation of suspected SAH after negative non-contrast CT.
Diagnostic workup of patients presenting with thunderclap headache and negative initial head CT remains a challenge, with most commonly employed strategies being lumbar puncture (LP) and CT angiography (CTA). The objective of this study was to determine the cost-effectiveness of these options. ⋯ LP should remain the preferred strategy for evaluation of SAH in patients presenting with thunderclap headache and negative non-contrast head CT. CTA is not an effective replacement, from either a utility or cost perspective.
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Clin Neurol Neurosurg · Mar 2016
Stratification of predictive factors to assess resectability and surgical outcome in clinoidal meningioma.
Meningiomas of the clinoidal region pose significant surgical challenges due to their close proximity and intimate relation with surrounding critical neurovascular structures. Our aim was to describe our institution's experience with the management of clinoidal meningiomas, identify predictive factors and develop a comprehensive grading system to assess the extent of resection. ⋯ A grading system can be employed in patients who present with clinoidal meningiomas and serve as an aid in planning an appropriate treatment strategy and establishing the prognosis. Radical resection can be planned in patients with favorable tumor criteria (groups 1) while a less aggressive surgical approach followed by stereotactic radiosurgery may be better suited for patients with less favorable tumor characteristics (group 2).