Journal of neurosurgery
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Journal of neurosurgery · Jul 2024
Predictors of occlusion, long-term outcomes, and safety in a cohort of 674 aneurysms treated with the Pipeline embolization device.
By providing a more physiological approach to the treatment of intracranial aneurysms, the Pipeline embolization device (PED) has revolutionized the endovascular treatment of aneurysms. Although there are many flow diverters on the market, the authors report their experience with the PED, the first flow diverter to be approved by the Food and Drug Administration. They aimed to assess the efficacy and safety of PED flow diversion for the treatment of a wide range of aneurysms, as well as to look at factors affecting occlusion. ⋯ The study findings are corroborated by those of previous studies and trials. The complete occlusion rate was 89.3% at 24 months' follow-up, with 94.8% of patients having favorable functional outcomes (mRS score 0-2). Aneurysm treatment before PED deployment and an increasing aneurysm neck diameter increase the risk of incomplete occlusion at 6 and 24 months.
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Journal of neurosurgery · Jul 2024
Navigated intraoperative ultrasound in neuro-oncology: volumetric accuracy and correlation with high-field MRI.
The use of intraoperative techniques to detect residual tumors has recently become increasingly important. Intraoperative MRI has long been considered the gold standard; however, it is not widely used because of high equipment costs and long acquisition times. Consequently, real-time intraoperative ultrasound (ioUS), which is much less expensive than MRI, has gained popularity. The aim of the present study was to evaluate the capacity of ioUS to accurately determine the primary tumor volume and detect residual tumors. ⋯ The authors' findings show that most brain tumors are well delineated by nioUS and almost perfectly correlated with MRI-based measurements both pre- and postoperatively. These data support the hypothesis that nioUS is a reliable intraoperative technique that can be used for real-time monitoring of brain tumor resections and to perform volumetric analysis of residual disease.
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Journal of neurosurgery · Jul 2024
Electrode position and cognitive outcome following deep brain stimulation surgery.
Subthalamic nucleus (STN) and globus pallidus internus (GPI) deep brain stimulation (DBS) effectively treat motor symptoms in Parkinson's disease (PD) but may be associated with cognitive and psychiatric changes in some patients. Evaluation of changes in cognitive and psychiatric symptoms following DBS is complicated by changes in these symptoms that occur as part of the natural disease course. The aim of this study was to evaluate whether electrode position was associated with changes in neurocognitive symptoms in patients who underwent STN and GPI DBS. ⋯ Cognitive change was observed in some patients with PD who underwent both GPI and STN DBS, likely due partly to underlying disease progression. Compared with GPI DBS, STN DBS was associated with a greater likelihood of cognitive decline. In STN but not GPI DBS, cognitive decline was associated with medialized electrode position, suggesting modulation of nonmotor STN divisions may contribute to cognitive changes following STN DBS.
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Abstracts of the Oral Presentations 2018 AANS Annual Scientific Meeting.
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Journal of neurosurgery · Jul 2024
Basal vein of Rosenthal classification: the key to venous outflow of the deep sylvian fissure.
Mastery of sylvian fissure dissection is essential to access lesions within the deep basal cisterns. The deep sylvian vein and its tributaries play a major role during access to and beyond the carotid cistern through the sylvian fissure and determine the complexity of microdissection. Preserving the venous outflow during sylvian fissure dissection is the best reliable strategy to prevent postoperative venous strokes or venous hypertension. The authors report the role of the basal vein of Rosenthal (BVR) in the venous outflow pattern of the deep sylvian cistern. ⋯ Preoperative assessment of the BVR anatomy is key to predict the deep sylvian venous pattern. The authors provide objective evidence supporting the reciprocal relationship between the type of BVR and the presence of a middle sylvian vein and the deep sylvian venous outflow. An immature BVR should alert the neurosurgeon of the high likelihood of finding a complex deep venous pattern, which may drive surgical planning.