Journal of neurosurgery
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Journal of neurosurgery · Jan 2025
Noncontrast imaging for the surveillance of treated and untreated meningiomas.
Patients with meningiomas require serial MRI for surveillance of tumor size and growth rate. The cost and resource requirements for contrast-enhanced MRI include intravenous cannulation, the contrast agent, risk of adverse reaction, and the time needed to acquire, review, and report the additional sequences. With repeated doses, gadolinium is known to accumulate in neural tissues. The authors compared the correlation and accuracy of axial T2-weighted imaging (T2WI) sequences alone for assessing tumor growth, dimensions, and dural venous sinus invasion compared with the current clinical practice of assessing both contrast-enhanced T1-weighted imaging (CE-T1WI) and T2WI sequences. ⋯ In patients with treated and untreated meningiomas, unenhanced T2WI can assess tumor dimensions, detect growth, and detect venous invasion with comparable reliability and accuracy to the current clinical practice of using both CE-T1WI and T2WI.
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Journal of neurosurgery · Jan 2025
The effect of delayed-release antibiotics on the rate of postoperative wound infection for implanted neuromodulatory devices.
Implanted neuromodulatory devices are important for the surgical management of pain, epilepsy, movement disorders, and spasticity. These devices are surgically implanted, but many must be periodically explanted and replaced as batteries deplete or devices fail. Replacement surgery risks further infections that require device explantation, incur large financial costs, and reduce patient quality of life. To reduce infection rates, a single surgeon began using vancomycin-impregnated absorbable calcium sulfate delayed-response beads with neuromodulatory device and intrathecal pump primary implantations and replacements. The infection rates when using vancomycin-impregnated beads were compared with previously published rates from the same surgeon. ⋯ The use of vancomycin-impregnated absorbable calcium sulfate beads was associated with a reduced rate of postoperative infection rates with implantable devices, and specifically for DBS primary implantation and replacement surgeries.
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Journal of neurosurgery · Jan 2025
Clinical and radiological presentation of cavernomas according to the Zabramski classification.
Cerebral cavernous malformations (CCMs) are a cluster of abnormal vessels of the brain. CCMs have a low risk for intracerebral hemorrhage and appear increasingly often as incidental findings on MRI. Zabramski classification has been used to describe the radiological features of CCMs. How the Zabramski classification associates with the clinical symptoms at presentation and clinical course of the disease is not well established. ⋯ Most CCMs are asymptomatic, incidental findings, in particular, nearly all Zabramski type IV CCMs. If symptoms are present, they are mainly associated with Zabramski type I CCMs and occasionally with Zabramski type II or III CCMs. Although most Zabramski type I CCMs will regress to type II or III and remain asymptomatic, over long-term follow-up, up to one-quarter develop new symptoms.