Journal of neurosurgery
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Journal of neurosurgery · Apr 2015
Multicenter StudyImpact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients.
The authors sought to determine the impact of resident participation on overall 30-day morbidity and mortality following neurosurgical procedures. ⋯ Cases with resident participation had higher rates of mortality and morbidity; however, these cases also involved patients with more comorbidities initially. On multivariate analysis, resident participation was not an independent risk factor for postoperative 30-day morbidity or mortality following elective or emergent neurosurgical procedures.
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Journal of neurosurgery · Apr 2015
Case ReportsProstate cancer with perineural spread and dural extension causing bilateral lumbosacral plexopathy: case report.
Perineural tumor spread in prostate cancer is emerging as a mechanism to explain select cases of neurological dysfunction and as a cause of morbidity and tumor recurrence. Perineural spread has been shown to extend from the prostate bed to the lumbosacral plexus and then distally to the sciatic nerve or proximally to the sacral and lumbar nerves and even intradurally. ⋯ The neoplastic nature of the process was confirmed by a sciatic nerve fascicular biopsy. The authors believe that transmedian dural spread allows continuity of a neoplastic process from one side of the body to the other.
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Journal of neurosurgery · Apr 2015
Concurrent use of the Pipeline Embolization Device and coils for intracranial aneurysms: technique, safety, and efficacy.
The use of the Pipeline Embolization Device (PED) as a sole endovascular modality has been described for the treatment of brain aneurysms. The benefit of using coils concurrently with a limited number of PEDs is not well documented. The authors describe their experience with this technique as well as their midterm clinical and angiographic results. ⋯ The deployment of PEDs with concurrent partially dense coiling is safe and efficacious. This technique achieved early complete occlusion and endovascular reconstruction of the parent vessel, without inducing mass effect. Favorable midterm clinical results were observed in all patients.
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Journal of neurosurgery · Apr 2015
Case ReportsIntegrated open surgical and endovascular embolization treatment of a paracavernous venous plexus fistula: case report.
The authors report the treatment of a rare type of dural arteriovenous fistula of the paracavernous venous plexus. These fistulas can mimic carotid-cavernous fistulas in both imaging characteristics and clinical presentation, but the anatomical differences require differences in management. The authors describe an integrated open surgical and direct endovascular embolization approach and review of the literature pertaining to the anatomy of and treatment options for paracavernous fistulas.
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Journal of neurosurgery · Apr 2015
Multisession stereotactic radiosurgery for large vestibular schwannomas.
Microsurgery is not the only option for larger vestibular schwannomas (VSs); recent reviews have confirmed the feasibility and efficacy of radiosurgery for larger VSs. This study illustrates the outcomes of a series of large VSs after multisession stereotactic radiosurgery (SRS). ⋯ The good control rate obtained with multisession SRS deepens the controversy of the radiobiology of VSs and may extend the indication of radiation therapy (fractionated or SRS) for large VSs to include patients without symptoms of mass effect. The limited number of cases and short follow-up period do not provide sufficient support for widespread application of multisession SRS in young patients. Further studies with multisession SRS are warranted.