Neurosurgical review
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Neurosurgical review · Oct 2015
ReviewThe current status of 5-ALA fluorescence-guided resection of intracranial meningiomas-a critical review.
Meningiomas are the second most common primary tumors affecting the central nervous system. Surgical treatment can be curative in case of complete resection. 5-aminolevulinic acid (5-ALA) has been established as an intraoperative tool in malignant glioma surgery. A number of studies have tried to outline the merits of 5-ALA for the resection of intracranial meningiomas. ⋯ However, only one study was able to consistently correlate resected tissue with histopathological results and nonspecific fluorescence of healthy brain tissue remains a confounder. The use of 5-ALA as a tool to guide resection of intracranial meningiomas remains experimental, especially in cases with tumor recurrence. The principle of intraoperative fluorescence as a real-time method to achieve complete resection is appealing, but the usefulness of 5-ALA is questionable. 5-ALA in intracranial meningioma surgery should only be used in a protocolled prospective and long-term study.
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In patients with traumatic brain injury (TBI) and ischemic hemispheric stroke (IHS), supratentorial decompressive craniectomy (DC) is performed when intracranial pressure (ICP) is unresponsive to medical treatment. There are numerous publications about the indications of supratentorial DC, the selection of patients eligible for surgery, the complications of the procedure, and the neurological outcome of operated patients. ⋯ Based on the literature reviewed, this article gathers features that had been developed with the intent to improve the decompressive effect of this surgery and evaluates if there is a strong recommendation for clinical practice. The existing literature does not supply class I evidence of how an ideal DC should be designed to reduce peri- and postoperative complications and to provide the best functional outcome.