Neurosurgery
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Randomized Controlled Trial
Conservative management or gamma knife radiosurgery for vestibular schwannoma: tumor growth, symptoms, and quality of life.
There are few reports about the course of vestibular schwannoma (VS) patients following gamma knife radiosurgery (GKRS) compared with the course following conservative management (CM). In this study, we present prospectively collected data of 237 patients with unilateral VS extending outside the internal acoustic canal who received either GKRS (113) or CM (124). ⋯ In VS patients, GKRS reduces the tumor growth rate and thereby the incidence rate of new treatment about tenfold. Hearing is lost at similar rates in both groups. Symptoms and QoL seem not to be significantly affected by GKRS.
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Randomized Controlled Trial
Multimodality word-finding distinctions in cortical stimulation mapping.
Cortical stimulation mapping (CSM) commonly uses visual naming to determine resection margins in the dominant hemisphere of patients with epilepsy. Visual naming alone may not identify all language sites in resection-prone areas, prompting additional tasks for comprehensive language mapping. ⋯ Distinct cortical areas were found for distinct input modalities, with language sites in anterior tip regions found most often by using auditory naming. The vulnerability of anterior temporal tip regions to resection in this population and distinct sites for each modality suggest that a multimodality approach may be needed to spare crucial language sites, if sparing those sites can be shown to significantly reduce the rate of postoperative language deficits without sacrificing seizure control.
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Controlled Clinical Trial
Cognitive functioning, emotional processing, mood, and personality variables before and after stereotactic surgery: a study of 8 cases with chronic neuropathic pain.
Stereotactic central lateral thalamotomy (CLT) has been applied as a treatment for chronic intractable neuropathic pain. However, it is not clear whether this intervention influences the emotional and cognitive impairments observed in patients who have chronic neuropathic pain. ⋯ For our patients with chronic neuropathic pain, CLT provided pain relief and reduction of their depression scores without causing postsurgical cognitive impairments.
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Intracranial in vivo recordings of individual neurons in humans are increasingly performed for a better understanding of the mechanisms of epileptogenesis and of the neurobiological basis of cognition. So far, information about the safety of stereotactic implantations and of magnetic resonance imaging (MRI) with hybrid depth electrodes is scarce. ⋯ Given the technical approach described here, precise targeting and safe use are possible with hybrid electrodes containing microwires for in vivo recording of human neuronal units.
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Demographics, hemorrhage risk, and results of surgical and endovascular treatment of spinal pial (type IV) arteriovenous fistulae (AVFs) across a large patient group have not been previously reported. ⋯ We demonstrate the utility of the Anson-Spetzler a-c subclassification and underscore the efficacy of surgical and endovascular spinal AVF treatment.