Journal of neurosurgery
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Journal of neurosurgery · Dec 2024
Local control and patient survival after stereotactic radiosurgery for esophageal cancer brain metastases: an international multicenter analysis.
This study aimed to evaluate local control (LC) of tumors, patient overall survival (OS), and the safety of stereotactic radiosurgery (SRS) for esophageal cancer brain metastases (EBMs). ⋯ SRS for EBMs demonstrated high survival rates and effective tumor control, with a low incidence of severe AREs. These findings highlight the potential role of SRS in the multidisciplinary multimodality management paradigm of EBM.
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Journal of neurosurgery · Dec 2024
Identification of the optimal thresholds for the hypoperfusion intensity ratio in moyamoya disease.
The authors' objective was to retrospectively compare two methods for defining the hypoperfusion intensity ratio (HIR) in moyamoya disease (MMD) by using hypoperfused volumes calculated from time to maximum of the residue function (Tmax) thresholds of 10 seconds/4 seconds and 10 seconds/6 seconds. ⋯ HIR10/4 exhibited a superior predictive value for primary outcomes in MMD compared to HIR10/6. Additionally, HIR10/4 showed a significant association with angiographic collaterals, particularly in ischemic MMD cases. This study suggested that HIR defined as Tmax > 10 seconds/Tmax > 4 seconds may be more suitable than Tmax > 10 seconds/Tmax > 6 seconds in MMD.
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Journal of neurosurgery · Dec 2024
Efficacy and safety of intraoperative MRI in glioma surgery: a systematic review and meta-analysis of prospective randomized controlled trials.
Maximum extent of resection in glioma yields enhanced survival outcomes. The contemporary literature presents contradictory results regarding the benefit of intraoperative MRI (iMRI). This meta-analysis aimed to investigate the efficacy and safety of iMRI-guided surgery. ⋯ Intraoperative MRI outperforms conventional surgery in achieving complete glioma resections of all contrast-enhancing tumor portions, enhancing PFS without added risk. Intraoperative MRI is a tool that facilitates these aims without reducing safety in terms of neurological deficits and surgical complications.
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Journal of neurosurgery · Dec 2024
The impact of cerebrovascular steno-occlusive disease subtype on surgical and clinical outcomes after direct STA-MCA bypass surgery.
Although well-established in moyamoya disease (MMD), the role of direct superficial temporal artery (STA) to middle cerebral artery (MCA) bypass in non-MMD (N-MMD) cerebrovascular steno-occlusive syndromes remains controversial. Nonetheless, the recurrent stroke risk in patients with N-MMD, despite best medical management, remains exceedingly high-especially for those suffering from hypoperfusion-related ischemia. The study objective was to determine the relative safety and efficacy profiles of direct STA-MCA bypass surgery for MMD and N-MMD patients in a large contemporary cohort. ⋯ This robust cohort of MMD and N-MMD STA-MCA bypass cases highlights the safety and efficacy of a technically sound direct bypass across all subtypes of cerebrovascular steno-occlusive disease. Careful attention to preoperative MRI parameters, including hemispheric flow rates on NOVA imaging, may improve surgical risk stratification. Further examination of the benefits of adjunctive indirect bypass or dural synangiosis, especially for patients with N-MMD, remains warranted.