Neurosurgery
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The field of magnetic resonance imaging-guided high-intensity focused ultrasound surgery (MRgFUS) is a rapidly evolving one, with many potential applications in neurosurgery. The first of 3 articles on MRgFUS, this article focuses on the historical development of the technology and its potential applications in modern neurosurgery. The evolution of MRgFUS has occurred in parallel with modern neurological surgery, and the 2 seemingly distinct disciplines share many of the same pioneering figures. ⋯ More recently, technological advances have permitted the combination of high-intensity focused ultrasound along with magnetic resonance imaging guidance to provide an opportunity to effectively treat a variety of central nervous system disorders. Although challenges remain, high-intensity focused ultrasound-mediated neurosurgery may offer the ability to target and treat central nervous system conditions that were previously extremely difficult to address. The remaining 2 articles in this series will focus on the physical principles of modern MRgFUS as well as current and future avenues for investigation.
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Meta Analysis
Long-term follow-up of Chiari-related syringomyelia in adults: analysis of 157 surgically treated cases.
To determine the long-term outcome of surgically treated Chiari-related syringomyelia. ⋯ Our results confirmed that surgery is an effective and safe treatment of Chiari-related syringomyelia, with a 90% chance of long-term stabilization or improvement on average. Surgery should be proposed as soon as possible in patients with clearly progressing clinical features.
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Craniopharyngiomas are benign tumors that originate from squamous cell rests of the embryonal hypophyseal-pharyngeal duct located along the pituitary stalk. After their surgical resection, recurrence usually occurs in the region of the original tumor bed. Ectopic recurrence of craniopharyngiomas is extremely rare. It usually occurs either along the surgical route, because of direct surgical seeding, or at a distal location in the subarachnoid space, because of seeding along the cerebrospinal fluid pathways. We present 3 examples of ectopic recurrences of craniopharyngiomas. ⋯ Although ectopic recurrence of a craniopharyngioma is very rare, it should always be considered in the differential diagnosis of what appears to be a new tumor in a patient with a history of previously resected craniopharyngiomas. Long-term follow-up of patients with resected craniopharyngioma is very important.
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Although stereotactic radiosurgery is an established procedure for treating trigeminal neuralgia (TN), the likelihood of a prompt and durable complete response is not assured. Moreover, the incidence of facial numbness remains a challenge. To address these limitations, a new, more anatomic radiosurgical procedure was developed that uses the CyberKnife (Accuray, Inc., Sunnyvale, CA) to lesion an elongated segment of the retrogasserian cisternal portion of the trigeminal sensory root. Because the initial experience with this approach resulted in an unacceptably high incidence of facial numbness, a gradual dose and volume de-escalation was performed over several years. In this single-institution prospective study, we evaluated clinical outcomes in a group of TN patients who underwent lesioning with seemingly optimized nonisocentric radiosurgical parameters. ⋯ Optimized nonisocentric CyberKnife parameters for TN treatment resulted in high rates of pain relief and a more acceptable incidence of facial numbness than reported previously. Longer follow-up periods will be required to establish whether or not the durability of symptom relief after lesioning an elongated segment of the trigeminal root is superior to isocentric radiosurgical rhizotomy.