Surg Neurol
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We report our experience with keyhole approaches as favorable treatments for various intracranial aneurysms including multiple aneurysms and giant aneurysms. ⋯ The keyhole approaches, based on improvements in diagnostic imaging, advanced surgical instruments, and microsurgical skills, are effective and ideal craniotomy techniques in the hands of experienced neurosurgeons for the treatment of intracranial aneurysms, including multiple and giant aneurysms, in patients without diffuse SAH, severe cerebral vasospasm, and severe brain edema or brain swelling.
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Parasagittal meningioma is one that fills the parasagittal angle, with no brain tissue between the tumor and the SSS. Invasion of the SSS is a challenge for complete removal and, consequently, for recurrence of these tumors. The objective of this study was to analyze the factors that influenced the clinical outcome of patients with parasagittal tumors surgically treated. ⋯ Recurrence of parasagittal meningiomas predominated in males, in grades II/III tumors, after subtotal resection, and with more invasion of the SSS. Subtotal or total resections without sinus resection were considered adequate for treating these patients.
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Fractionated stereotactic radiotherapy (FSRT) combines the precision of stereotactic positioning with the radiobiologic advantage of dose fractionation. ⋯ Fractionated stereotactic radiotherapy is a high-precision technique. It is safe and feasible in the primary and adjuvant treatment of cavernous sinus meningiomas. Fractionated stereotactic radiotherapy allowed local control in more than 90% of patients.
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The present study was undertaken to evaluate 10% hydroxyethyl starch (HES 200/0.5) with regard to its clinical outcome and safety in the treatment of severe head injury. ⋯ The 10% HES (200/0.5) can be used in the treatment protocol of severe head injury. There is no definite bleeding complications documented by current dosage of HES. Besides, balanced fluid management can be achieved without causing serious pulmonary complications. However, a further randomized, prospective study is needed to define the actual benefit of HES in fluid management and clinical outcome.
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Controlled Clinical Trial
Magnesium sulfate: role as possible attenuating factor in vasospasm morbidity.
Among the many complications of SAH, one of the most important is vasospasm. Several treatment alternatives have been proposed for this condition, with far-from-ideal results being obtained. Magnesium sulfate recently returned to the scene (with still unproven benefit) as an adjuvant in the treatment of vasospasm. ⋯ Magnesium did not seem to interfere in vasospasm frequency but apparently acted favorably in decreasing morbidity and length of hospital stay.