Neurosurgery
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Review Case Reports Comparative Study
Intracranial epidural hematoma in newborn infants: clinical study of 15 cases.
Epidural hematoma (EDH) in newborn infants is rare. We have described the history of 15 newborns with EDH to provide a better understanding of this pathology. ⋯ This report highlights the clinicoradiological characteristics of newborn EDH, which occurs more frequently in newborns that experienced difficult delivery from a nulliparous mother. Surgery is not a rule; some patients can be managed with conservative treatment. The outcome is generally good.
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Brain metastases continue to be a major and growing challenge in oncology, but recent advances in surgery, radiosurgery, and chemotherapy have broadened the number of treatment options. Current approaches to the management of brain metastases focus on individualizing patient care based on factors including the Karnofsky Performance Status, the tumor histology, the number of metastases, and the status of the systemic disease. ⋯ Although there is no current standard treatment, some general guidelines are recommended for single metastases, oligometastases (two to three brain metastases), and multiple (four or more) brain metastases, and for new or recurrent disease. With advances in systemic therapy for cancer, the treatment of brain metastases is becoming an increasingly important determinant of the length of survival and quality of life for cancer patients.
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The past decade has been marked by significant improvements in the survival of patients with metastatic brain tumors, but the management of this disease presents a continuing challenge because of the varied nature of brain metastases and the limited survival time. Brain metastases are becoming more prevalent because of improvements in the treatment of extracranial lesions; this paradox brought together a seven-member multidisciplinary panel to discuss some of the most promising developments in imaging, surgical, and therapeutic techniques for metastatic brain tumors, and to address the perplexing challenges that remain. Their analyses are captured in this supplement, which begins here with an overview of metastatic brain cancer.
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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.
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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.