Journal of neurosurgery
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Journal of neurosurgery · May 2011
Petroclival meningiomas: study on outcomes, complications and recurrence rates.
Petroclival meningiomas are notoriously difficult lesions to manage surgically, given the critical neurovascular structures that are intimately associated with the tumors. In this paper, the authors' aim was to review their series of patients with petroclival meningiomas who underwent surgical treatment; emphasis was placed on evaluating modes of presentation, postoperative neurological outcome, complications, and recurrence rates. ⋯ Petroclival meningiomas still pose a formidable challenge to neurosurgeons. In their series, the authors used multiple skull base approaches and careful microneurosurgical technique to achieve a good functional outcome (Glasgow Outcome Scale Score 4 or 5) in 92% of patients, although the extent of gross-total resection was only 28%. The authors' primary surgical goal was to achieve maximal tumor resection while maintaining or improving neurological function. The authors favor the treatment of residual tumor or recurrent tumor with stereotactic radiosurgery.
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Journal of neurosurgery · May 2011
Portable head CT scan and its effect on intracranial pressure, cerebral perfusion pressure, and brain oxygen.
Follow-up head CT scans are important in neurocritical care but involve intrahospital transport that may be associated with potential hazards including a deleterious effect on brain tissue oxygen pressure (PbtO(2)). Portable head CT (pHCT) scans offer an alternative imaging technique without a need for patient transport. In this study, the investigators examined the effects of pHCT scans on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and PbtO(2) in patients with severe brain injury. ⋯ These data suggest that pHCT scans do not have a detectable effect on a critically ill patient's ICP, CPP, or PbtO(2).
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Journal of neurosurgery · May 2011
Case Reports Comparative StudyRecurrence rates after neuroendoscopic fenestration and Gamma Knife surgery in comparison with subtotal resection and Gamma Knife surgery for the treatment of cystic craniopharyngiomas.
The object of this study was to compare the recurrence rates of cystic craniopharyngiomas after neuroendoscopic cyst fenestration combined with Gamma Knife surgery (GKS) and after subtotal resection (STR) combined with GKS. ⋯ This investigation confirms that STR followed by GKS results in a lower recurrence rate than neuroendoscopy and GKS. Neuroendoscopy and GKS, however, results in a better preservation of endocrine function. These results suggest that a generalized multimodal approach including endoscopic fenestration in addition to GKS is hindered by higher recurrence rates.
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Journal of neurosurgery · May 2011
Gamma Knife surgery for convexity, parasagittal, and falcine meningiomas.
The aim of this study was to evaluate the outcomes in patients with convexity, parasagittal, or falcine meningiomas treated using Gamma Knife surgery (GKS) and to determine management strategy considering a risk of radiation-induced edema. ⋯ Gamma Knife surgery is an effective treatment for convexity, parasagittal, and falcine meningiomas as the initial or adjuvant treatment. However, GKS should be restricted to small- to medium-sized tumors, particularly in patients with primary tumors, because radiation-induced edema is more common in convexity, parasagittal, and falcine meningiomas than skull base meningiomas.
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Journal of neurosurgery · May 2011
Biography Historical ArticleBerengario da Carpi: a pioneer in neurotraumatology.
Berengario da Carpi was one of the most famous physicians of the 16th century, a recognized master of anatomy and surgery, an emblematic "Renaissance man" who combined his medical experience and engineering knowledge to design new surgical instruments, and effectively used the arts of writing and drawing to describe state-of-the-art medicine and provide illustrations of anatomical structures. His greatest contribution to medicine was to write the most important work on craniocerebral surgery of the 16th century, the Tractatus de Fractura Calvae sive Cranei (Treatise on Fractures of the Calvaria or Cranium), in which he described an entire set of surgical instruments to be used for cranial operations to treat head traumas that became a reference for later generations of physicians. This was a systematic treatise covering the mechanisms, classification, and medical and surgical treatment of head traumas, and can be considered a milestone in the history of neurotraumatology.