Journal of neurosurgery
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Journal of neurosurgery · Jul 2012
Randomized Controlled Trial Multicenter Study Comparative StudyCost-effectiveness of carotid artery stent placement versus endarterectomy in patients with carotid artery stenosis.
The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) demonstrated that the risk of the primary composite outcome of stroke, myocardial infarction (MI), or death did not differ significantly in patients with an average surgical risk undergoing carotid artery stenting (CAS) and those undergoing carotid endarterectomy (CEA). However, the cost associated with CAS may limit its broad applicability. The authors' goal in this paper was to determine the cost-effectiveness of CAS with an embolic-protection device versus CEA in patients with moderate to severe carotid artery stenosis who are at average surgical risk. ⋯ Although the CREST demonstrated equivalent results with CAS (compared with CEA) in patients at average surgical risk with severe carotid artery stenosis, broad applicability of CAS might be limited by the higher cost associated with this procedure.
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Journal of neurosurgery · Jul 2012
Case ReportsOptimized angiographic computed tomography with intravenous contrast injection: an alternative to conventional angiography in the follow-up of clipped aneurysms?
The purpose of this study was to evaluate the diagnostic accuracy of an optimized angiographic CT (ACT) program with intravenous contrast agent injection (ivACT) in the assessment of potential aneurysm remnants after neurosurgical clipping compared with conventional digital subtraction angiography (DSA). ⋯ By using an optimized image acquisition protocol as well as enhanced postprocessing algorithms, the noninvasive ivACT seems to achieve results comparable to those of conventional angiography in the follow-up of clipped cerebral aneurysms. The authors have shown that ivACT can provide reliable diagnostic information about potential aneurysm remnants after neurosurgical clipping with high sensitivity and specificity, sufficient for clinical decision making, at least for aneurysms in the anterior circulation located distal to the internal carotid artery. These preliminary results may be a promising step to replace conventional angiography by a noninvasive imaging technique in selected cases after aneurysm clipping.
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Journal of neurosurgery · Jul 2012
Case ReportsIntracerebral schwannoma presenting as classic temporal lobe epilepsy.
Schwannomas of the brain parenchyma are extremely rare, occurring mostly in children and young adults. Fewer than 50 cases have been reported in the English-language literature. Isolated temporal lobe epilepsy is a rare presentation of intracerebral schwannomas, with only 2 reported cases. ⋯ Histological, immunohistochemical, and electron microscopy examinations of the surgical specimen established a diagnosis of intracerebral schwannoma. Accurate diagnosis of intracerebral schwannomas is essential, particularly in younger patients, given the lesions' nature, amenity to resection, favorable long-term prognosis, and broad radiological differential. The etiology of these lesions remains unknown, and multiple proposed theories are reviewed.
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Journal of neurosurgery · Jul 2012
Case ReportsA new strategic neurosurgical planning tool for brainstem cavernous malformations using interactive computer graphics with multimodal fusion images.
In this study, the authors used preoperative simulation employing 3D computer graphics (interactive computer graphics) to fuse all imaging data for brainstem cavernous malformations. The authors evaluated whether interactive computer graphics or 2D imaging correlated better with the actual operative field, particularly in identifying a developmental venous anomaly (DVA). ⋯ The authors report a new method for automatic registration of preoperative imaging data from CT, MRI, and 3D rotational angiography for reconstruction into 1 computer graphic. The diagnostic rate of DVA associated with brainstem cavernous malformation was significantly better using interactive computer graphics than with 2D images. Interactive computer graphics was also useful in helping to plan the surgical access corridor.
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Journal of neurosurgery · Jul 2012
Timing of clinical grade assessment and poor outcome in patients with aneurysmal subarachnoid hemorrhage.
Timing of clinical grading has not been fully studied in patients with aneurysmal subarachnoid hemorrhage (SAH). The primary objective of this study was to identify at which time point clinical assessment using the World Federation of Neurosurgical Societies (WFNS) grading scale and the Glasgow Coma Scale (GCS) is most predictive of poor functional outcome. ⋯ Timing of WFNS grade assessment affects its prognostic value. Outcome after aneurysmal SAH is best predicted by assessing WFNS grade after neurological resuscitation.