Journal of neurosurgery
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Journal of neurosurgery · Dec 2011
Meta AnalysisCurrent comprehensive management of cranial base chordomas: 10-year meta-analysis of observational studies.
The role of surgery and adjuvant radiation therapy for cranial base chordomas is not well established. This meta-analysis measures the relationship of complete resection and type of adjuvant radiation therapy to 5-year progression-free survival (PFS) and overall survival (OS) of cranial base chordomas. ⋯ Patients with complete resection of cranial base chordomas have a prolonged 5-year PFS and OS. Adjuvant proton-beam, carbon ion, and modern fractionated photon radiation therapy techniques offered a similar rate of PFS and OS at 5 years.
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Journal of neurosurgery · Dec 2011
Research productivity in neurosurgery: trends in globalization, scientific focus, and funding.
While research is important for the survival, growth, and expansion of neurosurgery, little work has been done to quantify the status and trends of neurosurgical publications. The purpose of this bibliometric study was to quantitatively analyze trends in neurosurgical publications, including changes in worldwide productivity, study methodology, subspecialty topic, and funding. ⋯ Neurosurgical publications demonstrate continued increases in productivity as well as in global expansion, although US contributions remain dominant. Two challenges that the neurosurgical community is facing include the preponderance of case reports and review articles and the relative decline in NIH funding for US neurosurgical publications, as productivity has outpaced government financial support.
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Journal of neurosurgery · Dec 2011
Is postoperative intensive care unit admission a prerequisite for elective craniotomy?
Routine postoperative admission to the intensive care unit (ICU) is often considered a necessity in the treatment of patients following elective craniotomy but may strain already limited resources and is of unproven benefit. In this study the authors investigated whether routine postoperative admission to a regular stepdown ward is a safe alternative. ⋯ Routine ward admission for patients undergoing elective craniotomies with selective ICU admission appears safe; however, approximately 2% of patients may require a direct postoperative unplanned ICU admission. Patients with anticipated long operation times, extensive blood loss, and high anesthetic risks should be selected for postoperative ICU admission, but further study is needed to determine the preoperative factors that can aid in identifying and caring for these groups of patients.
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Journal of neurosurgery · Dec 2011
Use of in vivo near-infrared laser confocal endomicroscopy with indocyanine green to detect the boundary of infiltrative tumor.
Infiltrative tumor resection is based on regional (macroscopic) imaging identification of tumorous tissue and the attempt to delineate invasive tumor margins in macroscopically normal-appearing tissue, while preserving normal brain tissue. The authors tested miniaturized confocal fiberoptic endomicroscopy by using a near-infrared (NIR) imaging system with indocyanine green (ICG) as an in vivo tool to identify infiltrating glioblastoma cells and tumor margins. ⋯ Macroscopic fluorescence was effective for gross tumor detection, but NIR confocal endomicroscopy performed using ICG enhanced sensitivity of tumor detection, providing real-time true microscopic histological information precisely related to the site of imaging. This first-time use of such NIR technology to detect cancer suggests that combined macroscopic and microscopic in vivo ICG imaging could allow interactive identification of microscopic tumor cell infiltration into the brain, substantially improving intraoperative decisions.