Neurosurgery
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The treatment of craniopharyngiomas remains controversial in the absence of class I and class II data. Despite strong opinions advocating aggressive vs conservative approaches, few long-term outcome data exist. Conventional wisdom suspects drainage of craniopharyngioma cysts into the ventricle to cause aseptic meningitis/ventriculitis. We studied this approach systematically in a large group of patients followed for more than 15 years. ⋯ This is the largest series of craniopharyngiomas treated with cyst-ventricular shunting and radiotherapy with the longest follow-up. It shows that aseptic meningitis is vastly overestimated and a never event in this series. Long-term outcome of this approach is significantly superior to aggressive resection with concomitantly lower morbidity/mortality.
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Differences between centers in patient outcome after subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms could be of relevance for the design of multicenter studies, particularly randomized clinical trials (RCTs), and standardization of management practices for improved quality of care for all patients. This study was aimed at investigating whether differences in outcome exist between centers enrolling patients into RCTs in SAH, and, if so, quantifying such center effect. ⋯ The outcomes of patients who are enrolled into multicenter clinical trials in SAH differ considerably between centers and regions. The reasons and implications of these findings should be studied, as such might lead to improvement in some aspects of trial design and management practices.
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Low-grade gliomas (LGGs) comprise a diverse set of intrinsic brain tumors that correlate strongly with survival. Data on the effect of reoperation are sparse. ⋯ This is among the largest studies to assess variables associated with outcome in patients with reoperated LGG. Reresection appears to provide significant benefit, and extent of resection remains the strongest predictor of OS.
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Diffuse intrinsic pontine gliomas (DIPGs) represent a particularly lethal type of pediatric brain cancer with no effective therapeutic options. Our laboratory has previously reported the development of genetically engineered DIPG mouse models by using the RCAS/tv-a system, including a model driven by PDGF-B, H3.3K27M, and p53 loss. These models can serve as a platform in which to test novel therapeutics before the initiation of human clinical trials. ⋯ In summary, an unbiased in vitro drug screen identified BMS-754807 as a potential therapeutic agent in DIPG, but BMS-754807 treatment in vivo by systemic delivery did not significantly prolong survival of DIPG-bearing mice.
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Odontoid fracture is a common injury, particularly in elderly, fall-prone patients. Previous studies comparing surgical and nonoperative management have classified elderly patients as all individuals over 65 years, or those 65 to 80 years. We compare surgical and nonoperative management in octogenarians (>79 years), a medically distinct population. ⋯ Type II odontoid fracture is highly morbid among octogenarians, with 1-year mortality approaching 1-in-2. Neither surgical nor nonoperative management is associated with a survival benefit. Cord injury, GCS, AIS, and ISS are significant predictors of poor prognosis.