Journal of neurosurgery
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Journal of neurosurgery · Dec 2008
Clipping of very large or giant unruptured intracranial aneurysms in the anterior circulation: an outcome study.
Patients with very large or giant unruptured intracranial aneurysms present with ischemic stroke and progressive disability. The aneurysm rupture risk in these patients is extreme-up to 50% in 5 years. In this study the authors investigated the outcome of surgical treatment for these very large aneurysms in the anterior circulation. METHODS Clinical data on 62 patients who underwent surgery for unruptured aneurysms (20-60 mm) between 1998 and 2006 were reviewed. ⋯ The treatment of very large or giant unruptured intracranial aneurysms is hazardous and complex and thus best performed only at major cerebrovascular centers with an experienced team of neurosurgeons, interventional neuroradiologists, neurologists, and neuroanesthesiologists. Surgery, with acceptable risks and excellent occlusion rates, is typically the treatment of choice in patients younger than 50 years of age. In older patients, the benefits of endovascular treatment versus surgery versus no treatment must be carefully weighed individually. Minimizing temporary occlusion and the consequent use of intraoperative angiography may help reduce surgical complications.
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Journal of neurosurgery · Dec 2008
Prognostic factors and grading systems for overall survival in patients treated with radiosurgery for brain metastases: variation by primary site.
The authors conducted a study to determine whether prognostic factors and the applicability of prognostic systems vary by primary tumor site in patients treated with radiosurgery for brain metastases. ⋯ Favorable prognostic factors for patients with newly diagnosed brain metastases treated with radiosurgery vary by primary site. The 4 prognostic grading systems analyzed were applicable to different primary sites depending on which prognostic factors each individual system incorporated. Therefore, the authors recommend further development and use of primary-specific prognostic systems.
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Journal of neurosurgery · Dec 2008
Endovascular treatment of intracranial microarteriovenous malformations.
Microarteriovenous malformations (micro-AVMs) are an uncommon subgroup of brain AVMs defined by a nidus measuring < 1 cm in diameter. The clinical features, angiographic characteristics, and outcomes in patients with micro-AVMs who had been treated endovascularly after presenting with hemorrhage were reviewed to identify common features affecting prognosis. ⋯ Immediate complete obliteration of a micro-AVM with a high permanent cure and low morbidity rates was accomplished using endovascular treatment. Early embolization after bleeding should be considered as an alternative to resection.
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Journal of neurosurgery · Dec 2008
Effect of electrical stimulation of the cervical spinal cord on blood flow following subarachnoid hemorrhage.
Cervical spinal cord stimulation (SCS) increases global cerebral blood flow (CBF) and ameliorates cerebral ischemia according to a number of experimental models as well as some anecdotal reports in humans. Nonetheless, such stimulation has not been systematically applied for use in cerebral vasospasm. In the present study the authors examined the effect of cervical SCS on cerebral vasoconstriction in a double-hemorrhage model in rats. ⋯ Data in this study showed that SCS can reverse BA constriction and improve global CBF in this SAH model. Spinal cord stimulation may represent a useful adjunct in the treatment of vasospasm.
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Journal of neurosurgery · Dec 2008
Treatment of arteriovenous malformations using Gamma Knife surgery: the experience at the University of Washington from 2000 to 2005.
The purpose of this study was to examine the efficacy and toxicity of treating arteriovenous malformations (AVMs) with the model 3C Gamma Knife at the University of Washington Medical Center. ⋯ Gamma Knife surgery is an effective treatment for AVMs, resulting in an excellent obliteration rate with acceptable toxicity.