Journal of neurosurgery
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Journal of neurosurgery · Mar 2013
Adjustment of the endoscopic third ventriculostomy entry point based on the anatomical relationship between coronal and sagittal sutures.
The coronal suture is often used as an empirical landmark for the entry point for endoscopic third ventriculostomy. The trajectory for the approach is often drawn based on midsagittal MRI findings. However, because the coronal suture is not perpendicular to the midline, this method may be inaccurate. ⋯ The position of a bur hole for endoscopic third ventriculostomy should be moved posteriorly with respect to the coronal suture the more laterally it is placed. Although the adjustment is small, it may be crucial. Failure to make this adjustment may result in suboptimal bur hole placement and increase the risk of morbidity.
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Journal of neurosurgery · Mar 2013
Exogenous hormone use, reproductive factors, and risk of intracranial meningioma in females.
The 2-fold higher incidence of meningioma in women compared with men has long suggested a role for hormonally mediated risk factors, but specific mechanisms remain elusive. ⋯ The authors' study confirms associations for body mass index, breastfeeding, and cigarette smoking but provides little evidence for associations of reproductive and menstrual factors with meningioma risk. The relationship between current use of exogenous hormones and meningioma remains unclear, limited by the small numbers of patients currently on oral hormone medications and a lack of hormone receptor data for meningioma tumors.
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Journal of neurosurgery · Mar 2013
Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery.
Hearing loss after Gamma Knife surgery (GKS) in patients with vestibular schwannoma has been associated with radiation dose to the cochlea. The purpose of this study was to evaluate serviceable hearing preservation in patients with VS who were treated with GKS and to determine if serviceable hearing loss can be correlated with the dose to the cochlea. ⋯ With a median mean cochlear dose of 2.7 Gy, the majority of patients with serviceable hearing retained serviceable hearing 3 years after GKS. A mean cochlear dose less than 3 Gy was associated with higher serviceable hearing preservation.
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Journal of neurosurgery · Mar 2013
Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations.
Giant pituitary adenomas (> 4 cm in maximum diameter) represent a significant surgical challenge. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for these tumors. The authors present the results of EES for giant adenomas and analyze the advantages and limitations of this technique. ⋯ Endoscopic endonasal surgery provides effective initial management of giant pituitary adenomas with favorable results compared with traditional microscopic transsphenoidal and transcranial approaches.
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Journal of neurosurgery · Mar 2013
Cerebral revascularization and carotid artery resection at the skull base for treatment of advanced head and neck malignancies.
Resection of cancer and the involved artery in the neck has been applied with some success, but the indications for such an aggressive approach at the skull base are less well defined. The authors therefore evaluated the outcomes of advanced skull base malignancies in patients who were treated with bypass and resection of the internal carotid artery (ICA). ⋯ Despite maximal surgical intervention, including ICA sacrifice at the skull base with revascularization, patient survival was dismal, and the complication rate was significant. The authors no longer advocate such an aggressive approach in this patient population. On rare occasions, however, such an approach may be considered for low-grade malignancies.