Neurosurgery
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Case Reports
Extravascular papillary endothelial hyperplasia mimicking neoplasm after radiosurgery: case report.
Papillary endothelial hyperplasia (PEH) is a rare form of exuberant reactive endothelial proliferation that can mimic neoplasm. We report the largest series of patients with histologically confirmed intracranial extravascular PEH developing in the field of previous treatment with stereotactic radiosurgery. ⋯ The interval to the development of PEH ranged from 5 months to 6 years, 10 months. Clinical follow-up was available for 3 of the 4 patients. None of these 3 patients have demonstrated evidence of recurrence during a mean follow-up period of 22 months (range, 15-30 months). These patients share common radiological features, potentially allowing preoperative diagnosis and improved guidance of clinical management. These cases suggest a link between radiosurgery and the development of PEH. These findings also suggest that PEH should be considered in the differential diagnosis for patients treated with radiosurgery in whom a hemorrhagic mass lesion subsequently develops at or near the site of previous treatment. We think that complete surgical excision is the best treatment for intracranial PEH.
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Epilepsy surgery involving the cingulate gyrus has been mostly presented as case reports, and larger series with long-term follow-up are not published yet. ⋯ Epilepsy surgery for lesions involving the cingulate gyrus represents a small fraction of all epilepsy surgery cases, with good seizure outcome and low rates of postoperative permanent deficits. In case of extended supracingular resection, supplementary motor area syndrome should be considered.
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Cranial base metastases (CBM) are rare and have received limited attention in the medical literature. Questions remain regarding the role of surgery, if any, in the management of these tumors. ⋯ The goal of surgery for CBM is to provide symptom relief and to preserve functional status in well-selected cases. Patient selection is critical because the surgery is usually palliative, and only a minority of patients are surgical candidates. Radiation therapy remains the management option of choice for the majority of patients.
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Factors during neurosurgical residency that are predictive of an academic career path and promotion have not been defined. ⋯ Defined in-training factors including number of total publications, number of first-author publications, and program size are predictive of residents choosing and succeeding in an academic career path.
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Chronic subdural hematoma (CSDH) is commonly seen in neurosurgical practice, and the incidence is increasing. Treatment results are highly variable with respect to recurrences and complications. ⋯ The present data suggest that in surgical treatment of CSDH with burr hole craniostomy, extended preoperative corticosteroid administration is associated with a lower recurrence rate. The use of corticosteroids does not seem to be related to a higher incidence of complications and treatment-related death compared with the current literature.