Journal of neurosurgery
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Journal of neurosurgery · Feb 2011
Postoperative nausea and vomiting in patients after craniotomy: incidence and risk factors.
The purpose of this study was to assess the incidence and risk factors of postoperative nausea and vomiting (PONV) after craniotomy because most available data about PONV in neurosurgical patients are retrospective in nature or derive from small prospective studies. ⋯ The overall incidence of PONV within 24 hours after craniotomy was approximately 50%. One possible reason is that intracranial surgeries pose an additional and independent risk factor for vomiting, especially in female patients. Patients undergoing craniotomy should be identified as high-risk patients for PONV.
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Journal of neurosurgery · Feb 2011
Intratumoral hemorrhage and fibrosis in vestibular schwannoma: a possible mechanism for hearing loss.
Vestibular schwannomas (VSs) are benign lesions with an unpredictable natural history. Perhaps the greatest barrier to predicting which patients need treatment is our poor understanding of how these tumors cause hearing loss in the first place. In this case-control study, the authors investigated the relationship between preoperative hearing loss and histological changes such as intratumoral microhemorrhage and extensive fibrosis. ⋯ In this study, the authors have demonstrated a correlation between the extent of nonneoplastic histological changes, such as microhemorrhage and fibrosis, and hearing loss. This alternate hypothesis has the potential to explain many of the exceptions to previously described mechanisms of hearing loss in patients with VS. The advent of high-resolution MR imaging technology to identify microhemorrhages may provide a method to screen for patients with VS at risk for hearing loss.
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Journal of neurosurgery · Feb 2011
Intraoperative computed tomography registration and electromagnetic neuronavigation for transsphenoidal pituitary surgery: accuracy and time effectiveness.
The authors assessed the feasibility, anatomical accuracy, and cost effectiveness of frameless electromagnetic (EM) neuronavigation in conjunction with portable intraoperative CT (iCT) registration for transsphenoidal adenomectomy (TSA). ⋯ The use of iCT/MR imaging-guided neuronavigation for transsphenoidal surgery is a time-effective, cost-efficient, safe, and technically beneficial technique.
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Journal of neurosurgery · Feb 2011
Gamma Knife surgery for pituitary adenomas: factors related to radiological and endocrine outcomes.
Gamma Knife surgery (GKS) is a common treatment for recurrent or residual pituitary adenomas. This study evaluates a large cohort of patients with a pituitary adenoma to characterize factors related to endocrine remission, control of tumor growth, and development of pituitary deficiency. ⋯ Smaller adenoma volume improves the probability of endocrine remission and lowers the risk of new pituitary hormone deficiency with GKS. A higher margin dose offers a greater chance of endocrine remission and control of tumor growth.
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Journal of neurosurgery · Feb 2011
Case ReportsMinimally invasive repair of spontaneous intracranial hypotension.
Spontaneous spinal CSF leakage with the development of intracranial hypotension is a well-described entity. Cerebrospinal fluid leaks, mostly from the thoracic spine, are the major cause of spontaneous intracranial hypotension (SIH). Conservative treatment options include hydration, oral caffeine, and epidural blood patching. ⋯ The authors describe 4 cases of spontaneous spinal CSF leakage producing symptoms of intracranial hypotension. All patients had multiple spinal diverticula with an identified leaking level. The patients were treated using a minimally invasive approach via surgical correction of the meningeal diverticulum.