Journal of neurosurgery
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Journal of neurosurgery · Mar 2017
Comparative StudyComparative analysis of arteriovenous malformation grading scales in predicting outcomes after stereotactic radiosurgery.
OBJECTIVE Successful stereotactic radiosurgery (SRS) for the treatment of arteriovenous malformations (AVMs) results in nidus obliteration without new neurological deficits related to either intracranial hemorrhage (ICH) or radiation-induced complications (RICs). In this study the authors compared 5 AVM grading scales (Spetzler-Martin grading scale, radiosurgery-based AVM score [RBAS], Heidelberg score, Virginia Radiosurgery AVM Scale [VRAS], and proton radiosurgery AVM scale [PRAS]) at predicting outcomes after SRS. METHODS The study group consisted of 381 patients with sporadic AVMs who underwent Gamma Knife SRS between January 1990 and December 2009; none of the patients underwent prior radiation therapy. ⋯ The RBAS and the PRAS were more accurate when compared with the Spetzler-Martin grading scale (p = 0.03 and p = 0.01), Heidelberg score (p = 0.02 and p = 0.02), and VRAS (p = 0.03 and p = 0.02). CONCLUSIONS SRS provides AVM obliteration without functional decline in the majority of treated patients. AVM grading scales having continuous scores (RBAS and PRAS) outperformed integer-based grading systems in the prediction of AVM obliteration without mRS score decline after SRS.
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Journal of neurosurgery · Mar 2017
Endoscopic endonasal surgery for nonadenomatous, nonmeningeal pathology involving the cavernous sinus.
OBJECTIVE Surgery within the cavernous sinus (CS) remains a controversial topic because of the delicate and complex anatomy. The risk also varies with tumor consistency. Softer tumors such as pituitary adenomas are more likely to be surgically treated, while firm tumors such as meningiomas are often treated with radiosurgery. ⋯ An advantage of this method is the relief of preexisting cranial neuropathies with low risk for new neurological deficit. Extent of resection within the CS varies with KS grade and degree of carotid encasement irrespective of the underlying pathology. The goals of surgery should be clearly established preoperatively in consultation with radiation and medical oncologists.
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Journal of neurosurgery · Mar 2017
Impact of Glasgow Coma Scale score and pupil parameters on mortality rate and outcome in pediatric and adult severe traumatic brain injury: a retrospective, multicenter cohort study.
OBJECTIVE Prediction of death and functional outcome is essential for determining treatment strategies and allocation of resources for patients with severe traumatic brain injury (TBI). The aim of this study was to evaluate, by using pupillary status and Glasgow Coma Scale (GCS) score, if patients with severe TBI who are ≤ 15 years old have a lower mortality rate and better outcome than adults with severe TBI. METHODS A retrospective cohort analysis of patients suffering from severe TBI registered in the Trauma Registry of the German Society for Trauma Surgery between 2002 and 2013 was undertaken. ⋯ CONCLUSIONS This study found that severe TBI in children aged ≤ 15 years is associated with a lower mortality rate and superior functional outcome than in adults. Also, children admitted with a missing motor response or fixed and bilaterally dilated pupils also have a lower mortality rate and higher functional outcome than adults with the same initial presentation. Therefore, patients suffering from severe TBI, especially pediatric patients, could benefit from early and aggressive treatment.
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Journal of neurosurgery · Mar 2017
Novel technique of a multifunctional electrosurgical system for minimally invasive surgery.
Bipolar electrosurgery in the minimally invasive endoscopic surgery theater has been traditionally limited to the use of standard bipolar forceps, which are minimally versatile, have a limited range of motion, and are associated with visualization and handling constraints. The authors designed a novel surgical device system in which commonly used surgical instruments (suction, microscissors, micrograspers, and dissectors) co-function as individually insulated and modular electrodes for bipolar electrosurgery. ⋯ This prototype system provided improved bipolar instrument mobility, minimized the requirement to exchange surgical instruments when performing electrosurgery, and allowed for new maneuvers that optimized surgical workflow, such as the ability to suction blood and smoke while cauterizing. This multifunctional bipolar cautery system may improve surgical efficiency and workflow and facilitate surgical microdissection and electrocautery during minimally invasive, endoscopic, robotic or traditional open surgery.
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Journal of neurosurgery · Mar 2017
Language pathway tracking: comparing nTMS-based DTI fiber tracking with a cubic ROIs-based protocol.
OBJECTIVE Diffusion tensor imaging (DTI) fiber tracking (FT) has been widely used in glioma surgery in recent years. It can provide helpful information about subcortical structures, especially in patients with eloquent space-occupying lesions. This study compared the newly developed navigated transcranial magnetic stimulation (nTMS)-based DTI FT of language pathways with the most reproducible protocol for language pathway tractography, using cubic regions of interest (ROIs) for the arcuate fascicle. ⋯ For specifically tracking the arcuate fascicle, however, the cubic ROIs-based approach showed better results (97.3% vs 75.7% with nTMS-based DTI FT). CONCLUSIONS The cubic ROIs-based protocol was designed for arcuate fascicle tractography, and this study shows that it is still useful for this intention. However, superior results were obtained using the nTMS-based DTI FT for visualization of other language-related fiber tracts.