World Neurosurg
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Stroke remains one of the most devastating of all neurological diseases, often causing death or gross physical impairment or disability. As numerous countries throughout the world undergo the epidemiological transition of diseases, trends in the prevalence of stroke have dramatically changed. ⋯ The global burden of stroke is high, inclusive of increasing incidence, mortality, DALYs, and economic impact, particularly in low- and middle-income countries. The implementation of better surveillance systems and prevention programs are needed to help track current trends as well as to curb the projected exponential increase in stroke worldwide.
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Gross total resection (GTR) prolongs survival but is unfortunately not achievable in the majority of patients with glioblastoma multiforme (GBM). Cytoreductive debulkings may relieve symptoms of mass effect, but it is unknown how long such effects sustain and to what degree the potential benefits exceed risks. We explore the impact of surgical morbidity on functional outcome and survival in unselected GBM patients. ⋯ Patients with perioperative complications and surgically acquired deficits were less likely to receive adjuvant therapy. While cytoreductive debulking may not improve survival in GBM, it may decrease the likelihood of patients receiving adjuvant therapy that does.
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Review
Acute ischemic stroke in the setting of cervical carotid occlusion: a proposed management strategy.
Occlusion of the extracranial internal carotid artery, whether a result of atherothrombosis or dissection, is a challenging cause of ischemic stroke, characterized by a dismal natural history and a poor response to systemic thrombolysis. ⋯ In all cases, the importance of prompt and timely recanalization through aggressive intra-arterial therapy cannot be overemphasized.
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Parasagittal meningiomas are either treated with conservative surgery or aggressive surgery with extensive vascular reconstructions to achieve radicality. The optimal management is subject to controversy. A prerequisite for good management and for design of relevant studies is the knowledge of natural history after radical and subtotal surgery. ⋯ A 25-year follow-up was necessary to estimate the long-term outcomes of parasagittal meningiomas. It is necessary to consider long-term recurrences and morbidity as important factors when managing patients with parasagittal meningiomas whose life expectancies are not diminished by old age or co-morbidities. The long-term outcomes must also be considered when evaluating different treatment modes, as "cure" of parasagittal meningiomas cannot be evaluated without sufficient follow-up.