Neurosurgery
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Preoperative Stratification of Transsphenoidal Pituitary Surgery Patients Based on Surgical Urgency.
Currently, there is no prioritization scale available to distinguish those patients with pituitary tumors who require urgent surgical intervention from those who are candidates for elective treatment. ⋯ We developed a risk stratification schema that may serve as a platform to streamline care to the patients at highest risk. The expert opinions presented provide a basis for future studies regarding the risk prioritization of patients.
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Surgical resection of brainstem cavernous malformations (BSCMs) is challenging, and patient selection and timing of intervention remain controversial. ⋯ Although BSCM surgery is associated with significant perioperative morbidity and mortality, favorable long-term hemorrhage rates and symptom resolution can be achieved in a carefully selected group of patients. Overall, patients treated acutely, within 6 weeks, benefited the most from surgical intervention.
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Intraoperative identification and preservation of the corticospinal tract is often necessary for glioma resection. ⋯ Persistent MEP loss or deterioration is associated with a high probability of new deficits. It seems recommendable to stop the subcortical resection before obtaining a subcortical MEP threshold at 3 mA especially in patients with preoperative motor deficits. A careful selection of muscles for the registration of MEPs is mandatory to avoid deficits in nonmonitored muscles.