Journal of neurosurgery
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Journal of neurosurgery · Oct 2010
Stereotactic radiosurgery for deep-seated cavernous malformations: a move toward more active, early intervention. Clinical article.
The role of radiosurgery in the treatment of cavernous malformations (CMs) remains controversial. It is frequently recommended only for inoperable lesions that have bled at least twice. Rehemorrhage can carry a substantial risk of morbidity, however. The authors reviewed their practice of treating deep-seated inoperable CMs to assess the complication rate of radiosurgery, the impact that radiosurgery might have on rebleeding, and whether a more active, earlier intervention is justified in managing this condition. ⋯ Stereotactic radiosurgery is a safe management strategy for CMs in eloquent sites with the marked advantage of reducing rebleed risks in patients with repeated pretreatment hemorrhages. The benefit in treating CMs with a single bleed is less clear. Note, however, that repeated hemorrhage carries a significant risk of increased morbidity far in excess of any radiosurgery-related morbidity, and the authors assert that this finding justifies the early active management of deep-seated CMs.
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Journal of neurosurgery · Oct 2010
Predictors of long-term shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. Clinical article.
The purpose of this study was to identify predictors of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH). ⋯ These data suggest that permanent CSF diversion after aneurysmal SAH may be independently predicted by hyperglycemia at admission, findings on the admission CT scan (Fisher Grade 4, fourth ventricle intraventricular hemorrhage, and bicaudate index ≥ 0.20), and development of nosocomial meningitis. Future research is needed to assess if tight glycemic control, reduction of fourth ventricle clot burden, and prevention of nosocomial meningitis may reduce the need for permanent CSF diversion after aneurysmal SAH.
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Journal of neurosurgery · Oct 2010
The impact of therapeutic modality on outcomes following repair of ruptured intracranial aneurysms: an administrative data analysis. Clinical article.
Enrolling a selected sample of ruptured intracranial aneurysms, the International Subarachnoid Aneurysm Trial (ISAT) found endovascular coiling to be superior to microsurgical clipping. The performance of coiling in a more general population of ruptured aneurysms has not been adequately studied. ⋯ The results of the current analysis call into question the generalizability of the ISAT to all ruptured aneurysms. Given the limitations inherent in this form of analysis, further clinical studies—rigorously assessing the performance of endovascular therapy in patients with non-ISAT-like aneurysms—are indicated.
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Journal of neurosurgery · Oct 2010
Case ReportsRepeated rupture of a middle meningeal artery aneurysm in moyamoya disease. Case report.
A case of moyamoya disease associated with subarachnoid hemorrhage and intracerebral hematoma resulting from repeated rupture of a middle meningeal artery aneurysm is reported. The aneurysm was progressively enlarged over a period of 1 month and was treated with middle meningeal artery embolization. The treatment method is discussed.
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Journal of neurosurgery · Oct 2010
The presigmoid approach to anterolateral pontine cavernomas. Clinical article.
Anterolateral cavernomas of the pons have been surgically removed via a variety of approaches, commonly retrosigmoid or transventricular. The goal in this study was to evaluate the presigmoid approach as an alternative. ⋯ The presigmoid approach is recommended for the resection of anterolateral pontine cavernomas. With this approach, the need for cerebellar retraction is nearly eliminated. The lateral "presigmoid" entry point creates a trajectory that allows complete resection of even deep lesions at this level, or anterior to the internal acoustic meatus.