Journal of neurosurgery
-
Journal of neurosurgery · Jan 2020
Comparative StudyComparative effectiveness analysis of Pipeline device versus coiling in unruptured aneurysms smaller than 10 mm.
Both endovascular coiling and the Pipeline embolization device (PED) have been shown to be safe and clinically effective for treatment of small (< 10 mm) aneurysms. The authors conducted a comparative effectiveness analysis to compare the utility of these treatment methods in terms of health benefits. ⋯ With the increasing use of PEDs for treatment of small unruptured aneurysms, the current study indicates that these devices may have higher health benefits due to lower rates of retreatment compared to both simple coiling and stent-assisted techniques. Longer follow-up studies are needed to document the rates of recurrence and retreatment after coiling and PED to assess the cost-effectiveness of these strategies.
-
Journal of neurosurgery · Jan 2020
Second-look strokectomy of cerebral infarction areas in patients with severe herniation.
Decompressive craniectomies (DCs) are performed on patients suffering large cerebral infarctions. The efficacy of this procedure has been demonstrated in several trials. In some cases, however, this procedure alone is not sufficient and patients still suffer refractory elevations of intracranial pressure (ICP). The goal of this study was to determine whether resection of infarcted tissue, termed strokectomy, performed as a second-look procedure after DC, improves outcome in selected cases. ⋯ In this study in comparison to former studies, mortality rates were lower and clinical outcome was comparable to that of previously published trials regarding large cerebral infarctions. Second surgery including strokectomy may help achieve better outcomes, especially in cases of infarction of more than one vascular territory.
-
Journal of neurosurgery · Jan 2020
Predictors of neoangiogenesis after indirect revascularization in moyamoya disease: a multicenter retrospective study.
The effect of indirect revascularization to improve cerebral perfusion for moyamoya disease (MMD) is based on ingrowth of new vessels into the cortical brain. Preoperative indicators for neoangiogenesis would be helpful to the selection of appropriate procedures for MMD patients but have not yet been investigated. Our study aimed to identify potential predictors for neovascularization after indirect bypass surgery. ⋯ Hemorrhagic onset predicts poor neovascularization after indirect bypass surgery for MMD patients. Abundant ICA moyamoya vessels indicate good neoangiogenesis after indirect bypass and vice versa, whereas absent ICA moyamoya vessels predict poor revascularization. Good neovascularization was associated with better long-term outcome. Future studies are needed to further address this issue and clarify the underlying pathophysiological mechanisms.
-
Journal of neurosurgery · Jan 2020
Case ReportsIntraoperative facial motor evoked potential monitoring for pontine cavernous malformation resection.
The aim of this study was to predict postoperative facial nerve function during pontine cavernous malformation surgery by monitoring facial motor evoked potentials (FMEPs). ⋯ FMEPs can be used to monitor facial nerve function during surgery for pontine cavernous malformations, especially when the suprafacial triangle approach is performed.
-
Journal of neurosurgery · Jan 2020
Case ReportsClinical characteristics of and treatment protocol for trapped temporal horn following resection of lateral ventricular trigone meningioma: a single-center experience.
Trapped temporal horn (TTH) is a rare subtype of loculated hydrocephalus that is often managed surgically. The natural history of TTH is not well understood, and there are few data on the outcomes of conservative management of this condition. The aim of this study was to analyze the clinical features and outcomes of conservatively and surgically managed cases of TTH. ⋯ The majority of patients with TTH presented in a delayed fashion. TTH is not always a surgical entity. Spontaneous resolution of TTH may be under-reported. Conservative management with clinical and radiological follow-up is effective in selected patients.