Journal of neurosurgery
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Journal of neurosurgery · Mar 2011
Risk factors for the development of serious medical complications after resection of meningiomas. Clinical article.
While the surgical and neurological risks of meningioma surgery have been reported, much less effort has been devoted to studying the rates of serious medical complications following such a procedure. The authors performed a review of 834 patients who underwent craniotomy for meningioma at their institution and analyzed the rate of major cardiac, pulmonary, renal, and hepatic complications. ⋯ Overall, the authors found that the rate of clinically detected serious medical complications is relatively low in this population (6.8%), given the duration and complexity of the meningioma operations, and is strongly linked to the subsequent development of significant medical complications. This information may be useful to surgeons in discussing the morbidity of surgery during the informed consent process.
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Journal of neurosurgery · Mar 2011
Randomized Controlled TrialCounterbalancing risks and gains from extended resections in malignant glioma surgery: a supplemental analysis from the randomized 5-aminolevulinic acid glioma resection study. Clinical article.
Accumulating data suggest more aggressive surgery in patients with malignant glioma to improve outcome. However, extended surgery may increase morbidity. The randomized Phase III 5-aminolevulinic acid (ALA) study investigated 5-ALA-induced fluorescence as a tool for improving resections. An interim analysis demonstrated more frequent complete resections with longer progression-free survival (PFS). However, marginal differences were found regarding neurological deterioration and the frequency of additional therapies. Presently, the authors focus on the latter aspects in the final study population, and attempt to determine how safety might be affected by cytoreductive surgery. ⋯ Extended resections performed using a tool such as 5-ALA-derived tumor fluorescence, carries the risk of temporary impairment of neurological function. However, risks are higher in patients with deficits unresponsive to steroids.
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Journal of neurosurgery · Mar 2011
Hemangiopericytoma: long-term outcome revisited. Clinical article.
Hemangiopericytomas are rare tumors that behave aggressively with a high rate of local recurrence and distant metastases. With the aim of determining the outcome and response to various treatment modalities, a series of 39 patients who underwent microsurgical resection for primary meningeal hemangiopericytoma over a 24-year period is presented. ⋯ The mean follow-up of this patient series represents the longest follow-up duration published to date and demonstrates extended survival in a significant number of patients with hemangiopericytoma. Gross-total resection followed by adjuvant EBRT provides patients with the highest probability of an increased recurrence-free interval and overall survival. Prolonged survival justifies long-term follow-up and aggressive treatment of initial, recurrent, and metastatic disease.
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Journal of neurosurgery · Mar 2011
Non-watertight dural reconstruction in meningioma surgery: results in 439 consecutive patients and a review of the literature. Clinical article.
There are various schools of thought when it comes to dural reconstruction following meningioma surgery, which are largely based on the personal experience of the individual surgeons. The authors' aim in this study was to review different dural reconstruction techniques, with an emphasis on their experience with the synthetic onlay dural graft technique. ⋯ In the authors' experience, the incidence of CSF leakage following non-watertight reconstruction of the dura mater in meningioma surgery performed using dural onlay graft was 0.4%. Graft-related complications occurred in 2.3%. These figures compare favorably to the majority of the series in which watertight dural closure is described and emphasized.
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Journal of neurosurgery · Mar 2011
Results with judicious modern neurosurgical management of parasagittal and falcine meningiomas. Clinical article.
The management of parasagittal and falcine meningiomas centers around the relationship between the tumor and the venous anatomy of the superior sagittal sinus (SSS) and the bridging veins. The present study aims to address surgical outcomes in a focused cohort of these patients for which there is not clinical equipoise between radiosurgery and transcranial resection. ⋯ Importantly, these data provide a more modern estimate of the expected outcomes that can be obtained with treatment of these tumors, in which a combination of image guidance, advanced microsurgical tools, and conformal radiation treatments is used.