Journal of neurosurgery
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Journal of neurosurgery · Oct 2023
Outcome of 107 conservatively managed unruptured brain arteriovenous malformations: a single center's 30-year experience.
Since the publication of A Randomized Trial of Unruptured Brain AVMs (ARUBA), the management of unruptured brain arteriovenous malformations (bAVMs) has been controversially discussed. Long-term follow-up data on the exclusively conservative management of unruptured bAVMs are scarce. The authors evaluated the long-term outcomes of patients with unruptured untreated bAVMs in a real-life cohort. ⋯ The authors' results represent the long-term course of unruptured untreated bAVMs. Their data support the conclusion that even in the post-ARUBA era, tailored active treatment options may be offered to patients with unruptured bAVMs. For patient counseling, individual risk factors should be weighed against the center's treatment-specific risks.
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Journal of neurosurgery · Oct 2023
Clinical presentation, hemorrhage risk, and outcome in patients with familial cavernous malformations: a pragmatic prospective analysis of 75 patients.
Newly diagnosed patients with a familial cavernous malformation (FCM) and their families are concerned about their future outlook, which is scarcely discussed in the literature. The authors studied a prospective contemporary cohort of patients with FCMs to assess demographics, mode of presentation, prospective risk of hemorrhage and seizures, need for surgery, and functional outcome over an extended interval. ⋯ The authors' findings provide clinically useful information on hemorrhage rate, seizure rate, the likelihood of surgery, and functional outcome. These findings can be helpful to practicing physicians when counseling patients with FCM and their families, who are often apprehensive about their future and well-being.
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Journal of neurosurgery · Oct 2023
Is brain invasion sufficient as a stand-alone criterion for grading atypical meningioma?
Despite the controversy surrounding brain invasion (BI) as the sole indicator used to diagnose atypical meningioma, this criterion was still incorporated in the 2021 WHO classification scheme. In this study, the authors investigated the reproducibility of this prognostic effect and the impact of BI on the prognosis in otherwise benign meningioma (benign meningioma with BI). ⋯ The findings demonstrate that benign meningioma with BI typically has an intermediate prognosis and can be differentiated from benign meningioma and classical atypical meningioma, which suggests that the importance of the diagnostic effect of BI is insufficiently accounted for in grading of atypical meningioma. Increased emphasis on the presence of BI in patients with atypical meningioma may be helpful in postsurgical decision-making and facilitating improvements in individual therapy.
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Journal of neurosurgery · Oct 2023
Convergence of the arcuate fasciculus and third branch of the superior longitudinal fasciculus with direct cortical stimulation-induced speech arrest area in the anterior ventral precentral gyrus.
The objective was to identify the correspondence between the anterior terminations of the arcuate fasciculus (AF) and third branch of the superior longitudinal fasciculus (SLF-III) and the intraoperative direct cortical electrical stimulation (DCS)-induced speech arrest area. ⋯ This study supports the key role of the left vPCGa as the speech output node by showing convergence between speech output mapping and anterior AF/SLF-III connectivity in the vPCGa. These findings may contribute to the understanding of speech networks and could have clinical implications in preoperative surgical planning.
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Journal of neurosurgery · Oct 2023
Femoral access site complications following neurointerventional procedures: economic implications at a single center.
Transfemoral access (TFA) has been the traditional route of arterial access for neurointerventional procedures. Femoral access site complications may occur in 2%-6% of patients. Management of these complications often requires additional diagnostic tests or interventions, each of which may increase the cost of care. The economic impact of a femoral access site complication has not yet been described. The objective of this study was to evaluate the economic consequences of femoral access site complications. ⋯ Although occurring relatively infrequently, femoral artery access site complications increase the cost of care for patients undergoing neurointerventional procedures; how this influences the cost effectiveness of neurointerventional procedures warrants further investigation.