Neurosurgery
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Case Reports Clinical Trial
Planning and simulation of neurosurgery in a virtual reality environment.
To report our experience with preoperative neurosurgical planning in our stereoscopic virtual reality environment for 21 patients with intra- and extra-axial brain tumors and vascular malformations. ⋯ The VIVIAN system allows users to work with complex imaging data in a fast, comprehensive, and intuitive manner. The 3-D interaction of this virtual reality environment is essential to the efficient assembly of surgically relevant spatial information from the data derived from multiple imaging techniques. The usefulness of the system is highly dependent on the accurate coregistration of the data and the real-time speed of the interaction.
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Biography Historical Article
Library: historical perspective. F.M.R. Walshe (1885-1973).
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Clinical Trial
How effective is endoscopic third ventriculostomy in treating adult hydrocephalus caused by primary aqueductal stenosis?
To evaluate the long-term efficacy of third ventriculostomies for adult patients with hydrocephalus caused by primary aqueductal stenosis. ⋯ In our experience, the long-term effectiveness of ETVs for adult patients with noncommunicating hydrocephalus was sufficient in only 50% of the cases. One-third of the patients exhibited temporary improvements, lasting 1 to 12 months (average duration, 5 mo) after the ETVs, and then demonstrated deterioration to even worse clinical conditions, despite patent ventriculostomies. All patients who did not exhibit permanent improvements after the ETVs benefited from shunt surgery. Efforts should be made to establish methods for the selection of patients for ETV or ventriculoperitoneal shunt surgery.
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Multicenter Study
Factors associated with aneurysm size in patients with subarachnoid hemorrhage: effect of smoking and aneurysm location.
Intracranial aneurysm size is an important determinant of risk of rupture and outcome after rupture. Risk factors influencing aneurysm formation and growth are not well defined. In this study, we examined the association between known risk factors for cerebrovascular disease and size of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage. ⋯ Cigarette smoking and middle cerebral artery origin seem to increase the risk for developing large aneurysms in patients predisposed to intracranial aneurysm formation. Further studies are required to investigate the mechanism underlying the association between cigarette smoking and intracranial aneurysm formation.
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Clinical Trial
Cognitive outcomes and long-term follow-up results after enhanced chemotherapy delivery for primary central nervous system lymphoma.
Patients with non-acquired immunodeficiency syndrome-related primary central nervous system lymphomas have the potential to achieve durable complete responses without radiotherapy, with treatment using enhanced chemotherapy delivery with blood-brain barrier disruption (BBBD). Reported 5-year survival rates with combined chemotherapy and radiotherapy were generally only 9 to 22% and were associated, in one study, with an overall 32% incidence of overt dementia and ataxia, which are dramatically increased among patients more than 60 years of age. ⋯ BBBD-enhanced chemotherapy delivery, without subsequent radiotherapy, resulted in favorable survival and cognitive outcomes for patients with primary central nervous system lymphomas who had not previously undergone irradiation. A cooperative multicenter study of intravenous chemotherapy without radiotherapy versus BBBD-enhanced chemotherapy would address the feasibility and necessity of performing a Phase III study for these rare central nervous system malignancies.