Journal of neurosurgery
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Journal of neurosurgery · Jul 2011
Clinical TrialQuantitative fluorescence in intracranial tumor: implications for ALA-induced PpIX as an intraoperative biomarker.
Accurate discrimination between tumor and normal tissue is crucial for optimal tumor resection. Qualitative fluorescence of protoporphyrin IX (PpIX), synthesized endogenously following δ-aminolevulinic acid (ALA) administration, has been used for this purpose in high-grade glioma (HGG). The authors show that diagnostically significant but visually imperceptible concentrations of PpIX can be quantitatively measured in vivo and used to discriminate normal from neoplastic brain tissue across a range of tumor histologies. ⋯ These findings are clinically profound because they demonstrate that ALA-induced PpIX is a targeting biomarker for a variety of intracranial tumors beyond HGGs. This study is the first to measure quantitative ALA-induced PpIX concentrations in vivo, and the results have broad implications for guidance during resection of intracranial tumors.
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Journal of neurosurgery · Jul 2011
Endovascular stent therapy for extracranial and intracranial carotid artery dissection: single-center experience.
The objective of this study was to evaluate endovascular stent therapy for carotid artery dissections (CADs). ⋯ Endovascular stent-assisted repair of extra- and intracranial CAD was safe and effective in this experience and can be recommended for selected patients. In particular, patients with symptomatic CADs that are not responsive to medical therapy should be considered for interventional treatment.
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Journal of neurosurgery · Jul 2011
Utility of diffusion tensor imaging in the acute stage of mild to moderate traumatic brain injury for detecting white matter lesions and predicting long-term cognitive function in adults.
Traumatic brain injury (TBI) often impairs cognitive function. Diffusion tensor (DT) imaging, a novel modality, permits evaluation of the effects of head trauma on white matter nerve fibers. The objectives of the current study were to investigate where the white matter injury following mild to moderate TBI is specifically located on DT imaging in the acute disease stage and to examine the relationship between the severity of the white matter lesion on DT imaging in the acute stage of TBI and future cognitive function in the chronic disease stage. ⋯ Fractional anisotropy reductions in the splenium and FWM in the acute stage of mild to moderate TBI may be a useful prognostic factor for long-term cognitive dysfunction.
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Journal of neurosurgery · Jul 2011
Endocrinological outcome after pituitary transposition (hypophysopexy) and adjuvant radiotherapy for tumors involving the cavernous sinus.
Stereotactic radiosurgery and fractionated stereotactic radiotherapy are commonly used in the treatment of residual or recurrent benign tumors of the skull base and cavernous sinus. A major risk associated with radiosurgical or radiotherapy treatment of residual or recurrent tumors adjacent to normal functional pituitary gland is radiation of the pituitary, which frequently leads to the development of hypopituitarism. The authors have used a technique of pituitary transposition to reduce the radiation dose to the normal pituitary gland in cases of planned radiosurgical treatment of residual tumor within the cavernous sinus. Here, the authors analyze the long-term endocrinological outcomes in patients with residual and recurrent tumors who undergo hypophysopexy and adjuvant radiosurgical or conformal fractionated radiotherapy treatment. ⋯ The increased distance between the normal pituitary gland and the residual tumor facilitates treatment of the tumor with radiosurgery or radiotherapy and effectively reduces the incidence of radiation injury to the normal pituitary gland when compared with historical controls.
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Journal of neurosurgery · Jul 2011
Comparative StudyEndovascular treatment of brain arteriovenous malformations with prolonged intranidal Onyx injection technique: long-term results in 350 consecutive patients with completed endovascular treatment course.
The purpose of this study was to present the authors' clinical experience and long-term angiographic and clinical follow-up results in 350 patients with brain arteriovenous malformations (AVMs) treated using prolonged intranidal Onyx injection with a very slow "staged" reflux technique described by the authors. ⋯ With the prolonged intranidal injection technique described herein, Onyx allows the practitioner to achieve higher rates of anatomical cures compared with the cure rates obtained previously with other embolic agents. More importantly, due to this technique's much more effective intranidal penetration, it allows high-grade AVMs to be made radiosurgically treatable in a group of patients for whom there has been no treatment alternative.