Neurosurgery
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The incidence of radiation-induced complications is increasingly part of the informed consent process for patients undergoing neuroendovascular procedures. Data guiding these discussions in the era of modern radiation-minimizing equipment is lacking. ⋯ Radiation exposures exceeding 2 Gy are common in interventional neuroradiology despite modern radiation-minimizing technology. The incidence of side effects approaches 40%, although the majority is self-limiting. Gaps in current models of brain tumor formation after exposure to radiation preclude accurately quantifying the risk of future CNS tumor formation.
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Cavernous malformations (CMs) in deep locations account for 9% to 35% of brain malformations and are surgically challenging. ⋯ Symptomatic deep CMs can be resected with acceptable morbidity and outcomes. Good preoperative modified Rankin Score and single hemorrhage are predictors of good long-term outcome.
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Endoscopic skull base surgery is now the preferred treatment option to remove skull base tumors. ⋯ EEA but not TTEA has a short-term (3 months) negative impact on patient's olfaction and mucociliary clearance. Patients should be informed about smell loss as a consequence of skull base surgery to prevent legal claims. Likewise, further research and some modifications on reconstruction flaps are encouraged to avoid damaging the olfactory neuroepithelium.
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Rat brain perfusion models are critical to basic research, but they can be imprecise and/or not durable for extended outcome studies. ⋯ Although meticulous in construction, this model creates ischemia more simply and more reliably than the Pulsinelli 4-vessel ischemia model that inspired it, with the inherent advantages of an isolated organ system, in which a known tissue volume is perfused at a predetermined volume and rate. This model permits robust long-term recovery.