Journal of neurosurgery
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The authors present their findings on growth patterns in a large series of surgically treated meningiomas en plaque of the sphenoid wing. ⋯ The goal of surgery is complete tumor removal without morbidity. An exact analysis of tumor growth and its involvement of different structures is mandatory before performing surgery.
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Journal of neurosurgery · Feb 2006
Comparative Study Clinical TrialFrameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique.
The gold standard for stereotactic brain biopsy target localization has been frame-based stereotaxy. Recently, frameless stereotactic techniques have become increasingly utilized. Few authors have evaluated this procedure, analyzed preoperative predictors of diagnostic yield, or explored the differences in diagnostic yield and morbidity rate between the frameless and frame-based techniques. ⋯ With regard to diagnostic yield and complication rate, the frameless stereotactic biopsy procedure was found to be comparable to or better than the frame-based method. Smaller and deep-seated lesions together were risk factors for a nondiagnostic tissue yield. Frameless stereotaxy may represent a more efficient means of obtaining biopsy specimens of cortical lesions but is otherwise similar to the frame-based technique.
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Journal of neurosurgery · Feb 2006
Phase II trial of conformal radiation therapy for pediatric patients with craniopharyngioma and correlation of surgical factors and radiation dosimetry with change in cognitive function.
A Phase II trial of conformal radiation therapy (CRT) for craniopharyngioma was conducted to determine whether the irradiated volume could be safely reduced to decrease effects on cognitive function. ⋯ The use of CRT with a 1-cm margin for clinical target volume results in tumor control equivalent to that achieved using conventionally planned radiation therapy. Surgical morbidity and a volume-receiving dose more than 45 Gy are factors affecting longitudinal IQ after CRT in patients treated for craniopharyngioma.
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Journal of neurosurgery · Feb 2006
A mathematical model of the natural history of intracranial aneurysms: quantification of the benefit of prophylactic treatment.
The International Study of Unruptured Intracranial Aneurysms (ISUIA) data raised new controversy regarding the threshold size that requires treatment. In particular, this study has been criticized for disagreeing with previous epidemiological data. ⋯ Under the author's assumptions, the prospective ISUIA data may be consistent with epidemiological findings. Prophylactic treatment for unruptured aneurysms may produce some benefits in large aneurysms if acceptable treatment risks can be assured, but it is not likely to offer improvement over the natural history for patients with small aneurysms.
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Journal of neurosurgery · Feb 2006
Simulation of the natural history of cerebral aneurysms based on data from the International Study of Unruptured Intracranial Aneurysms.
Despite recent publications of large-scale study data, controversy over the management of unruptured cerebral aneurysms continues. The low rupture rates in the International Study of Unruptured Intracranial Aneurysms (ISUIA) apparently contradicted surgeons' experiences with ruptured aneurysms. In the present study, based on data from the ISUIA, a mathematical model describing the natural history of cerebral aneurysms was developed. With this model, the author aimed to examine the validity of data from the ISUIA and to provide a better treatment guideline for unruptured aneurysms. ⋯ Findings in the present study validated the results of the ISUIA by showing that the seemingly low rupture rates could explain the statistical data for ruptured aneurysms. With the featured model, the author calculated the lifetime probability of lesion rupture--a useful measure for deciding on the optimal treatment for unruptured aneurysms.