Journal of neurosurgery
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Journal of neurosurgery · Sep 2003
Multicenter Study Comparative StudySurvival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project.
The Glioma Outcomes Project represents a contemporary analysis of the management of malignant (Grade III and Grade IV/GBM) gliomas in North America. This observational database was used to evaluate the influence of resection, as opposed to biopsy, on patient outcome as measured by the length of survival. Attempts were made to reduce the impact of selection bias by repeating the data analysis after omitting patients with major negative prognostic factors. ⋯ These data provide Class II evidence to support tumor grade, patient's age, and patient's functional status as prognostic factors for survival in individuals with recently diagnosed malignant gliomas. Resection (compared with biopsy) is also a strong prognostic factor; however, no quantitative attempt was made to assess the true extent of the resection.
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Journal of neurosurgery · Sep 2003
Comparative StudyThe role of multiple hyperbaric oxygenation in expanding therapeutic windows after acute spinal cord injury in rats.
Hyperbaric oxygenation (HBO) therapy has been reported to improve neurological recovery after spinal cord injury (SCI). In the present study, the authors examined whether multiple HBO therapy can expand the therapeutic window after acute SCI. ⋯ The results of this study demonstrate that multiple HBO treatments can expand the therapeutic window for acute SCI to 6 hours after injury.
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Journal of neurosurgery · Sep 2003
Titanium mesh cages for cervical spine stabilization after corpectomy: a clinical and radiological study.
Reconstruction after anterior cervical decompression has involved the use of tricortical iliac crest bone or fibular strut grafts, but has been associated with significant morbidity. In this study the authors evaluated the efficacy of titanium mesh cages (TMCs) for stability and fusion following anterior cervical corpectomy. ⋯ Thirty-seven patients were prospectively evaluated during a 4-year period. The majority presented with spinal cord compression (97%) often due to cervical spondylosis (87%). The TMC was filled with iliac crest bone chips or Surgibone and stabilized by anterior cervical plates (ACPs). The changes in settling ratio, coronal and sagittal angles, and sagittal displacement were determined at 3, 6, and 12 months; immediate postoperative radiographs were used as baseline. Flexion-extension radiographs and computerized tomography (CT) scans (obtained at 1 year) were examined to assess stability, fusion, and bone growth within the TMC. Complications such as settling, telescoping, migration, and pseudarthrosis were not observed. Dynamic radiography revealed spinal stability in all patients. Cage-related complications occurred in 2.7% (TMC malplacement [one patient]), surgery-related complications in 10.8%, and graft-related complications in 21.6%. Evidence of bone growth into the TMC was documented in 16 (95%) of 17 patients on CT scans. The mean cage height-related settling rates were 4.46% at 3 months (31 patients [p = 0.066]), 3.89% at 6 months (28 patients [p = 0.028]), and 4.35% at 1 year (27 patients [p = 0.958]). The mean sagittal displacement changed by 3.9% (23 patients [p = 0.73]). The mean coronal and sagittal angles changed 2.89 degrees (30 patients [p = 0.498]) and 2.09 degrees (29 patients [p = 0.001]) at 1 year, respectively, or at last follow up from baseline. No significant differences in the radiological indices were seen when multilevel vertebrectomy cases were compared with single-level vertebrectomy (p = 0.221), smoking status, or age. Conclusions. Titanium mesh cages, in combination with ACPs, are safe and effective for vertebral replacement in the cervical spine.
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Journal of neurosurgery · Sep 2003
Comparative StudyIn vitro biomechanical effects of reconstruction on adjacent motion segment: comparison of aligned/kyphotic posterolateral fusion with aligned posterior lumbar interbody fusion/posterolateral fusion.
Posterior lumbar interbody fusion (PLIF) was developed to overcome the limitations of posterolateral fusion in correcting spinal deformity and maintaining lumbar lordosis. In this study the authors compare the biomechanical effects of three different posterior reconstructions on the adjacent motion segment. ⋯ Compared with kyphotic posterolateral fusion, PLIF may lead to even higher load at the superior adjacent level because of the increased stiffness of the fixed segments even if local kyphosis is corrected by PLIF.
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Journal of neurosurgery · Sep 2003
Relative survival rates and patterns of diagnosis analyzed by time period for individuals with primary malignant brain tumor, 1973-1997.
The purpose of this study was to examine patterns of diagnosis and relative survival rates in individuals in whom a primary malignant brain tumor was diagnosed between 1973 and 1997; follow-up review of these patients continued through the end of 1999. ⋯ Over time, the relative survival rate of individuals with primary malignant brain tumor has improved and differences in survival are seen by examining the race of the patients.