Neurosurgery
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Patients with brain metastases were analyzed retrospectively to assess the risks and benefits of surgery with modern neurosurgical techniques, including image guidance coupled as indicated with corticography. ⋯ In most patients with single or multiple brain metastases, surgical resection reversed or stabilized neurological symptoms with therapeutic benefit, conveying a notable survival advantage without apparent increased risk, particularly in RPA Class I patients. In patients with Grade III single metastasis or RPA Class II multiple metastasis, surgical judgment should be exercised, and stereotactic radiosurgery boost treatment may be preferable. An algorithm for treatment of brain metastases is proposed.
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Cerebral revascularization with extracranial-to-intracranial bypass is often required during the surgical treatment of complex intracranial aneurysms. This report is the first in which a vertebral artery (VA)-to-middle cerebral artery (MCA) bypass in conjunction with endovascular coil embolization is used in the successful treatment of a giant intracranial aneurysm. ⋯ This report describes a safe and definitive treatment option for a giant intracranial ICA aneurysm using a posterior-to-anterior circulation (VA-MCA) bypass, followed by endovascular coil embolization in a patient with previous ligation of the common carotid artery. VA-MCA high-flow saphenous vein bypass followed by coil embolization is a useful technique that is especially valuable in the subset of giant aneurysm patients who have previously been treated by carotid ligation.
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Despite advances in both the surgical and endovascular treatment of intracranial aneurysms, wide-necked basilar tip aneurysms (i.e., basilar tip aneurysms in which both posterior cerebral arteries emanate from the base of a wide-necked aneurysm) represent a subset of aneurysms that continues to pose technical challenges in treatment. We sought to demonstrate the safety and short-term durability of a novel dual stent-assisted coil embolization technique. ⋯ These initial technical and clinical results are highly encouraging, and this technique may significantly improve the endovascular treatment of intracranial aneurysms.
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We report a series of 37 elderly patients who were surgically treated for intracranial meningioma in the ninth decade of life at our neurosurgical division between 1985 and 2002. ⋯ Surgical removal of a meningioma in the elderly is a safe procedure if the preoperative ASA classification is I or II and if the KPS rating is at least 70. Age seems not to be an insuperable obstacle when adequate management of all risk factors has been obtained.
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The remote (more than 6 mo after injury) and isolated (not associated with any other cervical spinal fractures) Type II fractures of the odontoid (RI IIO) are unique in being inherently unstable and prone to malunion or nonunion, leading to cervical compressive myelopathy. The present study discusses their surgical management. ⋯ The patients with RI IIO may be divided into five groups on the basis of their differing management protocols. There is a considerable risk of delayed myelopathy unless surgical reduction and stabilization are performed. Posterior stabilization is the preferred option in dealing with these fractures. Despite the presence of severe neurological deficits and the prolonged duration of symptoms, a significant neurological improvement usually occurs after surgery.