Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Apr 2012
ReviewThe use of motor mapping to aid resection of eloquent gliomas.
Surgery remains one of the oldest and still most important forms of treatment for patients with glioma. The advantages of surgical resection for glioma must be balanced with the potential of operative morbidity to surrounding eloquent brain. To that end, advances in functional brain mapping allow for safer operations with more aggressive surgical resections. A brief history of motor mapping as well as its present day use in aiding resection of eloquent gliomas is discussed.
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The insula is a functionally and anatomically complex cortical structure that can be affected by both low-grade and high-grade gliomas. This complexity often prevents many neurosurgeons from attempting to surgically manage insular gliomas. This article reviews the anatomic and functional uniqueness of the insula and the surgical outcomes and lessons learned from previously reported surgical series. Successful management of insular gliomas, defined as maximal resection of the tumor without postoperative neurologic morbidity, can be achieved through a sophisticated understanding of the neurovascular structure of the insular region and an intraoperative functional mapping using cortico-subcortical electrical stimulation.
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Neurosurg. Clin. N. Am. · Apr 2012
ReviewRadiology: criteria for determining response to treatment and recurrence of high-grade gliomas.
The development of radiologic criteria for the assessment of response to treatment in high-grade gliomas (HGGs) has evolved considerably over the past few decades since the original response criteria based on computed tomography imaging. Accuracy and objectivity in the assessment of response to treatment of HGGs is necessary for altering treatment regimens, establishing accurate provider communication, and improving the quality of clinical trials. Future studies assessing emerging advanced neuroimaging techniques will facilitate the development of even more accurate evidence-based radiologic response criteria.
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Neurosurg. Clin. N. Am. · Jan 2012
Review Case ReportsAcute management of ruptured arteriovenous malformations and dural arteriovenous fistulas.
Arteriovenous malformations of the brain (AVMs) are a major cause of stroke in young, healthy individuals and present multiple diagnostic and therapeutic challenges, particularly in the acute setting. Although the flow hemodynamics, biology, epidemiology, and natural history of AVMs have been extensively studied, little data have been published on AVM surgery in the acute setting, and acute surgery has been claimed to possibly increase the risk of persistent neurological deficits. Although it is usually preferable to defer AVM surgery for a few weeks or months, acute surgical (open and endovascular) management is essential in specific clinical and radiological settings.
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Neurosurg. Clin. N. Am. · Jan 2012
ReviewEndovascular treatment of cranial arteriovenous malformations and dural arteriovenous fistulas.
Pial arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) are high-flow vascular lesions with abnormal communications between the arterial and venous system. AVMs are congenital lesions, whereas DAVFs are considered acquired lesions. ⋯ The primary goal of treatment is to eliminate the risk of bleeding or at least decrease it. Because the epidemiology, clinical presentation, and classification of AVMs and DAVFs have been covered in previous articles in this issue, the authors only briefly touch on these subjects as they relate to endovascular treatment.