Neurosurgery
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Meningiomas account for approximately one-third of brain tumors. Median length of stay (LOS) is 5 days with total charges equaling approximately $55 000. Early rehabilitation improves the functional outcome for patients after surgery. The primary goal was to analyze LOS as a direct result of surgical date and to characterize the individual variables that may impact hospital course, early access to rehabilitation, and long-term functional status. ⋯ Day of surgery plays a significant role in LOS for meningioma patients. Clinicians should remain aware of factors that may delay optimal patient discharge and early access to rehabilitation facilities. Studies are needed to assess the social variables that may affect LOS and the clinical and financial implications for extended hospital courses.
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Glioblastoma is the most common and aggressive primary human brain cancer. Noninvasive characterization of intratumor blood flow parameters may help guide clinical decision making. Beyond risk stratification and prognostication, tumor perfusion may inform treatment selection and serial monitoring of newer antiangiogenic targeted therapies. In this study, intra- and intertumor variations in blood volume were quantified by using a novel 3-D volumetric, dynamic-susceptibility contrast-enhanced (DSCE), T2*-weighted perfusion magnetic resonance (MR) analysis to determine associations with molecular features and clinical outcomes. ⋯ A distinct vasculogenic subtype of glioblastoma identified by quantitative MR perfusion voxel-based analysis was associated with unique molecular features and worse overall survival. Quantitative volumetric MR perfusion holds potential in characterizing intra- and intertumoral heterogeneity, and identifying biologically distinct, clinically relevant subsets of patients for risk stratification and treatment selection.
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The availability of stents has widened the indications of endovascular intervention for cerebral aneurysms. ⋯ In this propensity score-matched analysis, stent implantation reduced the overall recanalization of the coiled cerebral aneurysms. However, the use of stents should be carefully decided upon.
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The effect of timing of initiation of concurrent radiation and chemotherapy after surgery on outcome of patients with glioblastoma (GBM) remains unclear. ⋯ A short delay in the start of concurrent chemoradiation is beyond the classic paradigm of 4 weeks post-resection and may be associated with prolonged OS and PFS.
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Several studies have examined correlates between imaging features of neoplasm and patient survival or tumor genetic composition; however, few have generated predictive models robust enough to enter clinical practice. In this study, we use advanced pattern analysis and machine learning to identify a combination of imaging features on initial magnetic resonance (MR) images to predict overall survival and molecular subtype in patients with glioblastoma (GB). ⋯ Unlike prior studies, we analyzed the entirety of imaging data in an integrative fashion, leveraging the power of pattern analysis and machine learning to predict survival and molecular subtype with high accuracy and reproducibility in GB. Our noninvasive model utilizes multiparametric imaging obtained routinely for GB patients, making it readily translatable to the clinic.