Journal of neurosurgery
-
Journal of neurosurgery · Jan 2014
Fluid-fluid level in cystic vestibular schwannoma: a predictor of peritumoral adhesion.
The aim of this study was to evaluate the clinical results and surgical outcomes of cystic vestibular schwannomas (VSs) with fluid-fluid levels. ⋯ Cystic VSs with fluid-fluid levels more frequently adhered to surrounding neurovascular structures and had a less favorable surgical outcome. A possible mechanism of peritumoral adhesion is intratumoral hemorrhage and consequent inflammatory reactions that lead to destruction of the tumor-nerve barrier. These findings may be useful in predicting surgical outcome and planning surgical strategy preoperatively.
-
Journal of neurosurgery · Jan 2014
Velocity and pressure gradients of cerebrospinal fluid assessed with magnetic resonance imaging.
New approaches for understanding CSF motion in healthy individuals and patients with hydrocephalus and Chiari malformation are presented. The velocity and the pressure gradient of CSF motion were determined using phase contrast (PC) MRI. ⋯ The observed velocity and pressure gradient fields delineated the characteristics of the CSF motion and its similarities and differences among the healthy individuals and between them and the 2 patients. Although the present results did not provide general knowledge of CSF motion, the authors' method more comprehensively described the physiological properties of the CSF in the skull than conventional approaches that do not include measurements of pressure gradient fields.
-
Journal of neurosurgery · Jan 2014
The incidence of complications in elective cranial neurosurgery associated with dural closure material.
Dural closure with synthetic grafts has been suggested to contribute to the incidence of infection and CSF leak. The objective of this study was to assess the contribution of choice of dural closure material, as well as other factors, to the incidence of infection and CSF leak. ⋯ The use of synthetic dural closure material is not associated with surgical site infection and is associated with a reduced incidence of CSF leak. Modifiable risk factors exist for craniotomy complications that warrant vigilance and further study.
-
Journal of neurosurgery · Jan 2014
The accuracy of predicting survival in individual patients with cancer.
Estimating survival time in cancer patients is crucial for clinicians, patients, families, and payers. To provide appropriate and cost-effective care, various data sources are used to provide rational, reliable, and reproducible estimates. The accuracy of such estimates is unknown. ⋯ Although crucial, predicting the survival of cancer patients is difficult. In this study all physicians were unable to accurately predict longer-term survivors. Despite valuable clinical data and predictive scoring techniques, brain and systemic management often led to patient survivals well beyond estimated survivals.
-
The relentless natural progression of petroclival meningiomas mandates their treatment. The management of these tumors, however, is challenging. Among the issues debated are goals of treatment, outcomes, and quality of life, appropriate extent of surgical removal, the role of skull base approaches, and the efficacy of combined decompressive surgery and radiosurgery. The authors report on the outcome in a series of patients treated with the goal of total removal. ⋯ Total removal (Grade I or II resection) of petroclival meningiomas is achievable in 76.4% of cases and is facilitated by the use of skull base approaches, with good outcome and functional status. In cases in which circumstances prevent total removal, residual tumors can be followed until progression is evident, at which point further intervention can be planned.