Journal of neurosurgery
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Journal of neurosurgery · Dec 2008
Neuroimaging and quality-of-life outcomes in patients with brain metastasis and peritumoral edema who undergo Gamma Knife surgery.
Gamma Knife surgery (GKS) has been shown to be effective for treating many patients with brain metastasis. Some brain metastases demonstrate significant peritumoral edema; radiation may induce cerebral edema or worsening preexisting edema. This study was conducted to evaluate the imaging and neurobehavioral outcomes in patients with preexisting peritumoral edema who then undergo GKS. ⋯ Patients demonstrating a reduction in the BCM-20 score > 6, age < 65 years, and KPS score >or= 70 exhibited longer survival. Significant preexisting edema did not influence the tumor response or clinical outcome. The resolution of edema was related to better quality of life but not to longer survival.
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Journal of neurosurgery · Dec 2008
Case ReportsIntravascular ultrasonography-guided stent angioplasty of an extracranial vertebral artery dissection.
The authors report on a case of intravascular ultrasonography (IVUS)-guided stent angioplasty for iatrogenic extracranial vertebral artery (VA) dissection in a 49-year-old man after coil embolization for an unruptured aneurysm of the right posterior inferior cerebellar artery. Insignificant dissections occurred during the procedure. Postoperatively, the patient experienced gradually worsening posterior neck pain and headache, and follow-up angiography 8 months after the coil embolization revealed expansion of the dissection. ⋯ It was safe and feasible to treat extracranial VA dissections with stent placement under IVUS guidance. Intravascular environments are in real time with IVUS, and this technique is useful in the confirmation of a true lumen and evaluation of appropriate stent apposition. More clinical experience with this technique is necessary and mandatory, and devices with smaller diameters with improved trackability are essential for further introduction of IVUS into the field of endovascular neurosurgery.
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Journal of neurosurgery · Dec 2008
Gamma Knife surgery for trigeminal pain caused by benign brain tumors.
The authors report the effects of Gamma Knife surgery (GKS) on benign tumor-related trigeminal pain in patients who underwent follow-up for a mean 57.8 months. ⋯ Gamma Knife surgery appears to be an effective tool to treat benign tumor-related trigeminal pain and control tumor growth. Repeated GKS targeting the trigeminal root or ganglion can be considered a tool to enhance the efficacy of pain management if pain persists or recurs, but the optimum treatment dose needs further investigation.
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Journal of neurosurgery · Dec 2008
Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage.
The authors sought to determine frequency, risk factors, and impact on outcome of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage (SAH). ⋯ Approximately 20% of episodes of DCI after SAH are characterized by cerebral infarction in the absence of clinical symptoms. Asymptomatic DCI is particularly common in comatose patients and is associated with poor outcome. Strategies directed at diagnosing and preventing asymptomatic infarction from vasospasm in patients with poor-grade SAH are needed.
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Journal of neurosurgery · Dec 2008
Comparative Study Clinical TrialA prospective cohort study of microvascular decompression and Gamma Knife surgery in patients with trigeminal neuralgia.
The aim of this study was to analyze 1 surgeon's 4-year experience with microvascular decompression ([MVD], 36 patients) and Gamma Knife surgery ([GKS], 44 patients) in 80 consecutive patients with trigeminal neuralgia (TN). ⋯ In this nonrandomized prospective cohort trial of selected patients with potentially relevant intergroup differences, MVD was significantly superior to GKS in achieving and maintaining a pain-free status in those with TN and provided similar early and superior longer-term patient satisfaction rates compared with those for GKS. The complications of wound cerebrospinal fluid leakage, hearing loss, and persistent diplopia (1 case each in the MVD group) were not seen after GKS.