Neurosurgery
-
Review Comparative Study
Safety of heparinization for cerebral aneurysm coiling soon after external ventriculostomy drain placement.
Our practice has been to heparinize patients for cerebral aneurysm coiling even after recent external ventriculostomy drain (EVD) placement. The current medical literature cites a 12.5% symptomatic hemorrhage rate with heparinization after recent EVD placement. We reviewed our experience to determine our level of safety with this practice. ⋯ Heparinization for cerebral aneurysm coiling can be safely performed even after EVD placement within 24 hours, particularly if the activated prothrombin time is kept strictly controlled.
-
Review Comparative Study
Presentation, natural history, and management of carotid cavernous aneurysms.
We present the largest reported cohort of carotid cavernous aneurysms (CCA), comparing the neuro-ophthalmic presentation, complications, and outcome with and without endovascular treatment. ⋯ Endovascular treatment of carotid cavernous aneurysms leads to a significantly higher rate of pain resolution compared with untreated patients, even after adjusting for initial pain severity. Diplopia may not resolve after treatment. The results of this study underscore our approach indicating treatment only in cases of debilitating pain, visual loss from compression, or diplopia in primary gaze or in patients with risk factors for major complications such as pre-existing coagulopathy or sphenoid sinus erosion.
-
Radiosurgery offers patients with brain metastases an effective and minimally invasive treatment modality. Radiosurgery provides local tumor control and prolongs survival in select patients with brain metastases. ⋯ Treatment recommendations will be outlined in view of the available clinical data. Although surgery or radiosurgery with whole-brain radiotherapy remains an important option for patients with a solitary brain metastasis, radiosurgery with or without whole-brain radiotherapy should be considered in patients with a limited number of small tumors and a good prognosis.
-
This review discusses imaging techniques for the diagnosis, treatment, and monitoring of brain metastases. It assesses the various modalities on the basis of their respective advantages and limitations. Recent advances in imaging technologies provide evaluation that is more accurate for tumor localization, morphology, physiology, and biology. When used in combination, these technologies provide clinicians with a powerful diagnostic and prognostic tool for managing metastatic brain disease.
-
Review Case Reports
Pineal cyst apoplexy: case report and review of the literature.
Although most pineal cysts are clinically benign and asymptomatic, some can become symptomatic. Of the various symptomatic presentations, apoplexy is the rarest and most ill-defined. A comprehensive search of publications in the English language yielded 18 cases of pineal cyst apoplexy. We reviewed the literature to compare symptomatology and management strategies and their outcomes. ⋯ Pineal cyst apoplexy should always be considered when following a patient with a pineal cyst that becomes symptomatic. The most common symptom was severe headache of sudden onset or acute worsening. Other signs of hydrocephalus may or may not be present. Magnetic resonance imaging is essential to making a diagnosis. Although we believe that surgical resection is the most effective approach because it minimizes the risk for recurrence and complication, stereotactic aspiration has been used successfully to treat this condition.