Neurosurgery
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Review Comparative Study
Prophylaxis for deep venous thrombosis in craniotomy patients: a decision analysis.
We sought to determine the most efficient perioperative prophylactic strategy for deep venous thrombosis (DVT) in craniotomy patients by use of a decision analysis model. ⋯ Using decision analytic modeling, we have shown that mechanical prophylaxis yields outcomes in craniotomy patients superior to those of either unfractionated or low-molecular-weight heparin.
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Review Case Reports
Solitary thoracic osteochondroma: case report and review of the literature.
Osteochondromas are common benign bone tumors that rarely arise in the vertebral column. Intraspinal presentation of these tumors is usually circumscribed to the cervical regions with few tumors presenting in the thoracic vertebrae. We report a case of a thoracic solitary osteochondroma arising from within the vertebral body, review the cases reported in the literature, and propose recommendations for the surgical management of these challenging lesions. ⋯ Our case is atypical in that the tumor arose from the posterior portion of the T12 body, causing spinal cord dysfunction that necessitated an anterior approach to T12 for corpectomy with thoracolumbar fixation and fusion. Surgical intervention was effective in completely resolving the patient's right lower extremity weakness.
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Comparative Study Clinical Trial
Staged stereotactic irradiation for acoustic neuroma.
Stereotactic radiosurgery has proven effective in the treatment of acoustic neuromas. Prior reports using single-stage radiosurgery consistently have shown excellent tumor control, but only up to a 50 to 73% likelihood of maintaining hearing at pretreatment levels. Staged, frame-based radiosurgery using 12-hour interfraction intervals previously has been shown by our group to achieve excellent tumor control while increasing the rate of hearing preservation at 2 years to 77%. The arrival of CyberKnife (Accuray, Inc., Sunnyvale, CA) image-guided radiosurgery now makes it more practical to treat acoustic neuroma with a staged approach. We hypothesize that such factors may further minimize injury of adjacent cranial nerves. In this retrospective study, we report our experience with staged radiosurgery for managing acoustic neuromas. ⋯ Although still preliminary, these results indicate that improved tumor dose homogeneity and a staged treatment regimen may improve hearing preservation in acoustic neuroma patients undergoing stereotactic radiosurgery.
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Comparative Study Clinical Trial
Patient reports of satisfaction after microvascular decompression and partial sensory rhizotomy for trigeminal neuralgia.
There are no reports of patient satisfaction surveys after either a microvascular decompression (MVD) or a partial sensory rhizotomy (PSR) for trigeminal neuralgia. This study compares patient satisfaction after these two types of posterior fossa surgery for trigeminal neuralgia, because it is postulated that recurrences, complications, and previous surgical experience reduce satisfaction. ⋯ Patients undergoing posterior fossa surgery as a primary procedure are most satisfied and PSR patients are least satisfied, partly because of a higher rate of side effects.
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Case Reports
A highly vascular intracranial solitary fibrous tumor treated with radiotherapy and toremifene: case report.
A case of an unusual intracranial solitary fibrous tumor with features of high vascularity and resultant difficulty at resection is presented. The use of surgery, radiotherapy, and toremifene has been successful with no recurrence after 18 months. ⋯ The use of surgery, radiotherapy, and toremifene in treatment of a vascular intracranial solitary fibrous tumor has been successful and warrants further research.