Journal of neurosurgery
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Journal of neurosurgery · Dec 2008
Gamma Knife surgery for the treatment of melanoma metastases: the effect of intratumoral hemorrhage on survival.
Gamma Knife surgery (GKS) improves overall survival in patients with malignant melanoma metastatic to the brain. In this study the authors investigated which patient- or treatment-specific factors influence survival of patients with melanoma brain metastases; they pay particular interest to pre- and post-GKS hemorrhage. ⋯ These data corroborate previous findings that tumor burden (either as increased number or total volume of lesions) at the time of GKS is associated with diminished patient survival in those with intracerebral melanoma metastases. Patients who were noted to have hemorrhagic melanoma metastases prior to GKS appear to have a worse prognosis following GKS compared with patients with nonhemorrhagic metastases, despite similar rates of bleeding pre- and post-GKS treatment. Gamma Knife surgery itself does not appear to increase the rate of hemorrhage.
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Journal of neurosurgery · Dec 2008
Use of hybrid shots in planning Perfexion Gamma Knife treatments for lesions close to critical structures.
The authors investigated the use of different collimator values in different sectors (hybrid shots) when treating patients with lesions close to critical structures with the Perfexion model Gamma Knife. ⋯ The judicious use of hybrid shots in patients for whom the target is close to a critical structure is an efficient way to achieve conformal treatments while minimizing the beam-on time. The reduction in beam-on time with hybrid shots is attributed to a reduced use of blocked sectors and an increased number of high-value collimator sectors.
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Journal of neurosurgery · Dec 2008
Clipping of very large or giant unruptured intracranial aneurysms in the anterior circulation: an outcome study.
Patients with very large or giant unruptured intracranial aneurysms present with ischemic stroke and progressive disability. The aneurysm rupture risk in these patients is extreme-up to 50% in 5 years. In this study the authors investigated the outcome of surgical treatment for these very large aneurysms in the anterior circulation. METHODS Clinical data on 62 patients who underwent surgery for unruptured aneurysms (20-60 mm) between 1998 and 2006 were reviewed. ⋯ The treatment of very large or giant unruptured intracranial aneurysms is hazardous and complex and thus best performed only at major cerebrovascular centers with an experienced team of neurosurgeons, interventional neuroradiologists, neurologists, and neuroanesthesiologists. Surgery, with acceptable risks and excellent occlusion rates, is typically the treatment of choice in patients younger than 50 years of age. In older patients, the benefits of endovascular treatment versus surgery versus no treatment must be carefully weighed individually. Minimizing temporary occlusion and the consequent use of intraoperative angiography may help reduce surgical complications.
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Journal of neurosurgery · Dec 2008
Case ReportsIntravascular ultrasonography-guided stent angioplasty of an extracranial vertebral artery dissection.
The authors report on a case of intravascular ultrasonography (IVUS)-guided stent angioplasty for iatrogenic extracranial vertebral artery (VA) dissection in a 49-year-old man after coil embolization for an unruptured aneurysm of the right posterior inferior cerebellar artery. Insignificant dissections occurred during the procedure. Postoperatively, the patient experienced gradually worsening posterior neck pain and headache, and follow-up angiography 8 months after the coil embolization revealed expansion of the dissection. ⋯ It was safe and feasible to treat extracranial VA dissections with stent placement under IVUS guidance. Intravascular environments are in real time with IVUS, and this technique is useful in the confirmation of a true lumen and evaluation of appropriate stent apposition. More clinical experience with this technique is necessary and mandatory, and devices with smaller diameters with improved trackability are essential for further introduction of IVUS into the field of endovascular neurosurgery.
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Journal of neurosurgery · Dec 2008
Prognostic factors and grading systems for overall survival in patients treated with radiosurgery for brain metastases: variation by primary site.
The authors conducted a study to determine whether prognostic factors and the applicability of prognostic systems vary by primary tumor site in patients treated with radiosurgery for brain metastases. ⋯ Favorable prognostic factors for patients with newly diagnosed brain metastases treated with radiosurgery vary by primary site. The 4 prognostic grading systems analyzed were applicable to different primary sites depending on which prognostic factors each individual system incorporated. Therefore, the authors recommend further development and use of primary-specific prognostic systems.