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
Rupture rate for patients with untreated unruptured intracranial aneurysms in South Korea during 2006-2009.
The authors investigated the rupture rate among patients with untreated unruptured intracranial aneurysms (UIAs) in South Korea during 2006-2009. ⋯ The overview of the incidence of rupture indicates the need for a preventive strategy and future studies to prevent rupture in Asian patients with UIAs.
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Journal of neurosurgery · Jul 2012
Unruptured intracranial aneurysms in the Familial Intracranial Aneurysm and International Study of Unruptured Intracranial Aneurysms cohorts: differences in multiplicity and location.
Familial predisposition is a recognized nonmodifiable risk factor for the formation and rupture of intracranial aneurysms (IAs). However, data regarding the characteristics of familial IAs are limited. The authors sought to describe familial IAs more fully, and to compare their characteristics with a large cohort of nonfamilial IAs. ⋯ Heritable structural vulnerability may account for differences in IA multiplicity and location. Important investigations into the underlying genetic mechanisms of IA formation are ongoing.
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Journal of neurosurgery · Jul 2012
Long-term natural history of neurofibromatosis Type 2-associated intracranial tumors.
Neurofibromatosis Type 2 (NF2) is a heritable tumor predisposition syndrome that leads to the development of multiple intracranial tumors, including meningiomas and schwannomas. Because the natural history of these tumors has not been determined, their optimal management has not been established. To define the natural history of NF2-associated intracranial tumors and to optimize management strategies, the authors evaluated long-term clinical and radiographic data in patients with NF2. ⋯ Neurofibromatosis Type 2-associated intracranial tumors most frequently demonstrated a saltatory growth pattern. Because new tumors can develop in NF2 patients over their lifetime and because radiographic progression and symptom formation are unpredictable, resection may be best reserved for symptom-producing tumors. Moreover, establishing the efficacy of nonsurgical therapeutic interventions must be based on long-term follow-up (several years).
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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.