Neurosurgery
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The Novalis stereotactic radiotherapy system (BrainLAB, Heimstetten, Germany) allows for precise treatment of cranial base tumors with single-fraction radiosurgery. In some cases, however, proximity of the optic nerve and chiasm is a concern. In these cases, intensity-modulated stereotactic radiosurgery (IMRS) can be used to limit the dose to these structures. IMRS planning can be labor intensive, which poses a problem when it is performed on the day of treatment. We describe our methods and results of preprocedure planning for IMRS for patients with lesions in the cavernous sinus or parasellar regions in whom the dose to the optic nerve or chiasm might exceed our acceptable tolerance dose (8 Gy). ⋯ We believe this pretreatment technique streamlines the process for IMRS, allowing for better patient comfort and efficient physician time use.
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Subarachnoid hemorrhage (SAH) is cryptogenic in 15% of cases. Despite reports of proven recurrence, additional diagnostic studies are not often recommended when no abnormalities were identified on the initial study with digital subtraction angiography (DSA). In our retrospective review of outcomes after cryptogenic SAH, we identify diagnostic strategies that most often yielded the source of bleeding. ⋯ Compared with perimesencephalic SAH, nonperimesencephalic SAH was associated with significantly (P < 0.01) longer hospital and intensive care unit stays, greater complication rates, and worse outcomes. Positive findings after further work-up after initial negative DSA in 16% of our patient population confirms that cryptogenic SAH is not necessarily nonaneurysmal, but that a bleeding risk exists. Therefore, we advocate repeat DSA and/or computed tomographic angiography after cryptogenic SAH.
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Radiosurgery can be considered a well-established option for the treatment of arteriovenous malformations (AVMs). The exact application of the therapeutic dose is based on the availability of imaging data sets with superior image quality that can be superimposed using an image fusion algorithm. For follow-up studies, the quantitative comparison of the respective image data sets also plays an important role. Until now, digital subtraction angiography (DSA) has been a mandatory tool for treatment planning and follow-up procedures. The aim of this study was to investigate whether a suitable computed tomographic (CT) and/or magnetic resonance (MR) angiography procedure can replace DSA and, if so, in which cases. ⋯ By integrating all available imaging modalities, the exact three-dimensional definition of the AVM nidus was safely realized for all patients. Stereotactic DSA data acquisition remains a crucial tool for safe nidus definition in radiosurgery treatment planning and cannot, therefore, be discarded at present. It is recommended that a quantitative comparison of all MR follow-up studies be established.
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The microvascular anastomosis (MA) technique remains an important aspect of modern neurosurgical practice. Specialized training is essential for mastering the anastomosis of small vessels. To minimize animal use and to create a simple but realistic training model, we developed a pulsatile perfused arteries model based on turkey carotid arteries for microvascular anastomosis training. ⋯ The pulsatile perfused carotid arteries model presents a realistic MA training model. It provides an inexpensive and simple setup for educational purposes. This technique can minimize live animal and anesthesia needs for MA training. Wide use of this model may enhance and popularize MA training and education.
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Review Meta Analysis
Glioma extent of resection and its impact on patient outcome.
There is still no general consensus in the literature regarding the role of extent of glioma resection in improving patient outcome. Although the importance of resection in obtaining tissue diagnosis and alleviating symptoms is clear, a lack of Class I evidence prevents similar certainty in assessing the influence of extent of resection. ⋯ Despite persistent limitations in the quality of data, mounting evidence suggests that more extensive surgical resection is associated with longer life expectancy for both low- and high-grade gliomas.