Neurosurgery
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Diffusion magnetic resonance (MR) characteristics are a predictive imaging biomarker for survival benefit in recurrent glioblastoma treated with anti-vascular endothelial growth factor (VEGF) therapy; however, its use in large volume recurrence has not been evaluated. ⋯ Pretreatment diffusion MR imaging is an independent predictive biomarker for overall survival in recurrent glioblastoma with a large tumor burden. Large tumors with low ADCL have a survival benefit when treated with surgical resection, whereas large tumors with high ADCL may be best managed with bevacizumab.
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Comparative Study
Drug-Coated Balloon Dilation Compared With Conventional Stenting Angioplasty for Intracranial Atherosclerotic Disease.
Conventional stent-based angioplasty was challenged for the high incidence of perioperative complications and follow-up in-stent restenosis (ISR) in treating intracranial atherosclerotic disease (ICAD). Currently, the drug-coated balloon (DCB) has shown promise in preventing and treating ISR. ⋯ Compared with conventionally only stenting angioplasty, DCB dilation can effectively lower restenosis degree and total restenosis risk, with no superiority in symptomatic restenosis at 6-mo follow-up.
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Following Bayes theorem, ventriculomegaly and ataxia confer only a 30% chance of idiopathic Normal Pressure Hydrocephalus (NPH). When coupled with positive responses to best diagnostic testing (extended lumbar drainage), 70% of patients recommended for shunting will not actually have NPH. This is inadequate clinical care. ⋯ Because the Multidisciplinary NPH Clinic selected only 26% for surgery (corroborating 30% in Bayes theorem), an overwhelming majority of patients with suspected NPH will harbor alternative diagnoses. Identification of contributing/confounding conditions will support the meticulous work-up necessary to appropriately manage patients without NPH while optimizing clinical responses to shunting in correctly diagnosed patients.
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Biography Historical Article
Tribute to Milton D. Heifetz (1921-2015): The Man Behind the Heifetz Aneurysm Clip.
Milton Dave Heifetz (1921-2013) was a pioneer American neurosurgeon who spent the majority of his career at Cedars-Sinai Hospital in California. Heifetz greatly influenced the field of neurosurgery as an innovator, leader, and academic neurosurgeon. His redesign of the aneurysm clip addressed the long-standing issue of a fatiguing spring. ⋯ In 1975, he published The Right to Die: A Neurosurgeon Speaks of Death With Candor, a book which played a major role in our modern-day advanced directives. Throughout his life, Heifetz was an inspirational individual who consistently worked towards solutions to surgical and ethical problems. We present a historical vignette on his life, career, and contributions to neurosurgery.