Journal of neurosurgery
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Journal of neurosurgery · Feb 2016
Multicenter StudyOutcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study.
Chronic subdural hemorrhage (SDH) or hematoma is a condition that affects elderly individuals. With advances in medical care, the number of nonagenarians and centenarians will increase. However, surgical treatments in this age group are associated with high rates of morbidity and mortality. Because no data are available on the rates of survival among elderly patients with chronic SDHs who undergo surgical drainage or receive only conservative care, the goal of this study was to determine survival rates in patients 90 years of age or older with symptomatic chronic SDHs. ⋯ Surgical drainage of chronic SDHs in nonagenarians and centenarians is associated with lower incidence of inpatient death and higher 30-day and 6-month survival rates.
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Journal of neurosurgery · Feb 2016
Multicenter StudyGamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan.
The aim of this study was to explore the efficacy and safety of stereotactic radiosurgery for patients with facial nerve schwannomas (FNSs). ⋯ GKS is a safe and effective treatment option for patients with either primary or residual FNSs. All patients, including 1 patient who required repeat GKS, achieved good tumor control at the last follow-up. The incidence of newly developed or worsened preexisting facial palsy was 12% at the last clinical follow-up. In addition, the risk of hearing deterioration as an adverse effect of radiation was low. These results suggest that GKS is a safe alternative to resection.
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Journal of neurosurgery · Feb 2016
Time-delayed contrast-enhanced MRI improves detection of brain metastases and apparent treatment volumes.
Contrast-enhanced MRI is the preeminent diagnostic test for brain metastasis (BM). Detection of BMs for stereotactic radiosurgery (SRS) planning may improve with a time delay following administration of a high-relaxivity agent for 1.5-T and 3-T imaging systems. Metastasis detection with time-delayed MRI was evaluated in this study. ⋯ In patients who are being prepared for SRS of BMs, delayed MRI after contrast injection revealed more targets that needed treatment. In addition, apparent treatment volumes increased with a time delay. To avoid missing tumors that could be treated at the time of planned SRS and resultant "treatment failures," the authors recommend that postcontrast MR images be acquired between 10 and 15 minutes after injection in patients undergoing SRS for treatment of BMs.
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Journal of neurosurgery · Feb 2016
Finite element analysis of periventricular lucency in hydrocephalus: extravasation or transependymal CSF absorption?
Periventricular lucency (PVL) is often observed in the hydrocephalic brain on CT or MRI. Earlier studies have proposed the extravasation of ventricular CSF into the periventricular white matter or transependymal CSF absorption as possible causes of PVL in hydrocephalus. However, there is insufficient evidence for either theory to be conclusive. ⋯ The results are in accordance with common clinical findings of PVL. The degree of ventriculomegaly significantly influences the development of PVL, but two factors were not linearly correlated. The results are indicative of the transependymal CSF absorption as a possible cause of PVL, but the extravasation theory cannot be formally rejected.
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Journal of neurosurgery · Feb 2016
Editorial CommentEditorial: Randomized clinical trials and neurosurgery.