Journal of neurosurgery
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Journal of neurosurgery · Jan 2019
ReviewInsular glioma surgery: an evolution of thought and practice.
OBJECTIVEThe goal of this article is to review the history of surgery for low- and high-grade gliomas located within the insula with particular focus on microsurgical technique, anatomical considerations, survival, and postoperative morbidity. METHODSThe authors reviewed the literature for published reports focused on insular region anatomy, neurophysiology, surgical approaches, and outcomes for adults with World Health Organization grade II-IV gliomas. RESULTSWhile originally considered to pose too great a risk, insular glioma surgery can be performed safely due to the collective efforts of many individuals. ⋯ The transcortical approach and intraoperative mapping are useful tools to maximize safety. CONCLUSIONSThe insula's proximity to middle cerebral and lenticulostriate arteries, primary motor areas, and perisylvian language areas makes accessing and resecting gliomas in this region challenging. Maximal safe resection of insular gliomas not only is possible but also is associated with excellent outcomes and should be considered for all patients with low- and high-grade gliomas in this area.
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Journal of neurosurgery · Dec 2018
Review Case ReportsOptic pathway-hypothalamic glioma hemorrhage: a series of 9 patients and review of the literature.
OBJECTIVEHemorrhage (also known as apoplexy) in optic pathway gliomas (OPGs) is rare. Because of the variable presentations and low incidence of OPG hemorrhages, little is known about their clinical course and the best treatment options. The aim of this work was to review risk factors, clinical course, and treatment strategies of optic glioma hemorrhages in the largest possible number of cases. ⋯ CONCLUSIONSIntracerebral OPG hemorrhages have a fatal outcome in 20% of cases. Age, hormonal status, neurofibromatosis involvement, and histopathological diagnosis have been suggested as risk factors for hemorrhage, but this cannot be reliably established from the present series. The goals of surgery should be patient survival and prevention of further neurological and ophthalmological deterioration.
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Journal of neurosurgery · Nov 2018
ReviewNegative surgical exploration in patients with Cushing's disease: benefit of two-thirds gland resection on remission rate and a review of the literature.
OBJECTIVEThe authors report their single-institution experience with the pathological findings, rates of remission, and complications in patients with presumed Cushing's disease (CD) who underwent a two-thirds pituitary gland resection when no adenoma was identified at the time of transsphenoidal surgery (TSS). The authors also review the literature on patients with CD, negative surgical exploration, and histological findings. METHODSThis study is a retrospective analysis of cases found in neurosurgery and pathology department databases between 1989 and 2011. ⋯ Failure to find a discrete adenoma at the time of surgery occurs in at least 10%-15% of cases, even in experienced centers. The current literature provides little guidance regarding rational intraoperative approaches in such cases. The authors' experience with 161 patients with CD, when no intraoperative tumor was localized, demonstrates the utility of a two-thirds pituitary gland resection with a novel and effective surgical strategy, as suggested by a high initial remission rate and a low operative morbidity.
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Journal of neurosurgery · Nov 2018
ReviewKnowledge silos: assessing knowledge sharing between specialties through the vestibular schwannoma literature.
OBJECTIVEIt is common for a medical disorder to be managed or researched by individuals who work within different specialties. It is known that both neurosurgeons and neurotologists manage vestibular schwannoma (VS) patients. While overlap in specialty focus has the potential to stimulate multidisciplinary collaboration and innovative thinking, there is a risk of specialties forming closed-communication loops, called knowledge silos, which may inhibit knowledge diffusion. ⋯ CONCLUSIONSPartial knowledge silos are observed between neurosurgery and otolaryngology on the topic of VS, based on the peer-reviewed literature. The increase in access provided by the Internet and searchable online databases has not decreased specialty reference bias. These findings offer lessons to improve cross-specialty collaboration, physician learning, and consensus building.
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Journal of neurosurgery · Oct 2018
Meta AnalysisChemical venous thromboembolism prophylaxis in neurosurgical patients: an updated systematic review and meta-analysis.
Venous thromboembolism (VTE) is a common and potentially life-threatening complication. The risk of serious hemorrhagic complications when starting chemical prophylaxis for VTE prevention is a substantial concern for neurosurgeons. The objective of this study was to perform an updated systematic review and meta-analysis to determine if the rates of VTE and bleeding complications are different in patients undergoing chemoprophylaxis compared with placebo or mechanical prophylaxis alone following cranial or spinal procedures. ⋯ Based on moderate-to-good quality of evidence, chemoprophylaxis is beneficial in preventing VTE, with no significant increase in either major or minor bleeding complications in patients undergoing cranial and spinal procedures. Further research is needed to determine whether this conclusion holds true for more specific subpopulations.