Journal of neurosurgery
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Journal of neurosurgery · Mar 2018
Meta AnalysisMeta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults.
OBJECTIVE The purpose of this study was to evaluate treatment outcomes of future stroke prevention, perioperative complications, and angiographic revascularization in adults with symptomatic moyamoya disease (MMD) according to treatment modalities and surgical techniques. METHODS A systemic literature review was performed based on searches of the PubMed, Embase, and Cochrane Central databases. A fixed-effects model was used in cases of heterogeneity less than 50%. ⋯ Direct bypass was associated with better angiographic outcomes than indirect bypass (OR 6.832, p < 0.001). CONCLUSIONS Bypass surgery can be effective in preventing future stoke events in adults with MMD. Direct bypass seems to provide better risk reduction with respect to stroke than indirect bypass in these patients.
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Journal of neurosurgery · Mar 2018
Case ReportsIntradiploic encephalocele of the primary motor cortex in an adult patient: electrophysiological implications during surgery.
Encephaloceles are herniations of brain parenchyma through congenital or acquired osseous-dural defects of the skull base or cranial vault. Different types of symptoms, due to CSF fistulas, meningitis, or seizures, are often associated with this condition. The authors present a rare case of spontaneous right frontal parasagittal encephalocele in a 70-year-old man who was experiencing a spastic progressive paresis of his left lower limb. ⋯ Thus, the brain parenchyma was carefully released without resection to preserve motor function and, finally, a cranioplasty was performed. After a few months, the patient demonstrated considerable improvement in his left lower-limb function and, after 1 year, he had fully recovered. Intraoperative electrophysiological monitoring and mapping allowed for the determination of the best surgical strategy for the isolation of the encephalocele and correlated well with preoperative multimodal MRI.
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Journal of neurosurgery · Mar 2018
Surgery guided with intraoperative electrocorticography in patients with low-grade glioma and refractory seizures.
OBJECTIVE Using intraoperative electrocorticography (ECoG) to identify epileptogenic areas and improve postoperative seizure control in patients with low-grade gliomas (LGGs) remains inconclusive. In this study the authors retrospectively report on a surgery strategy that is based on intraoperative ECoG monitoring. METHODS A total of 108 patients with LGGs presenting at the onset of refractory seizures were included. ⋯ In these patients with epilepsy discharges located at the anterior part of the temporal lobe, satisfactory postoperative seizure control (93.3%) was achieved after resection of the tumor and the anterior part of the temporal lobe. CONCLUSIONS Intraoperative ECoG monitoring provided the exact location of epileptogenic areas and significantly improved postoperative seizure control of LGGs. In patients with temporal lobe LGGs, resection of the anterior temporal lobe with epileptic discharges was sufficient to control seizures.