World Neurosurg
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Gamma Knife radiosurgery (GKRS) represents a well-accepted treatment for small-medium vestibular schwannomas (VS); however, its application in larger VS is still controversial. ⋯ Surgical resection remains the primary approach for large VS with symptomatic brainstem compression. GKRS can be considered a safe and effective option in particular in patients who are not good candidates for surgery.
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We sought to investigate the postoperative morbidity and mortality rate of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) undergoing elective anterior cervical fusion (ACF). ⋯ Chronic and end-stage renal disease may significantly increase the risk of postoperative morbidity and mortality after ACF. Future research into preoperative optimization of these patients and on the potential benefits of undergoing surgery until after renal transplantation is warranted.
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Some patients suffer postoperative hearing loss even when the intraoperative auditory brainstem response (ABR) is preserved during vestibular schwannomas surgery. This study was conducted to evaluate whether there are dynamic changes of the ABR after surgery. ⋯ The study identifies ongoing changes of ABR quality and hearing function after the end of vestibular schwannoma surgery. Therefore it seems worthwhile to continue ABR monitoring in the postoperative phase in order to identify patients who are at risk of a secondary hearing deterioration and start therapeutic interventions in a timely manner.
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Recent prospective multicenter studies have shown that the probability of rupture of unruptured aneurysms with maximal diameter <7 mm is rather low. However, the overall risks and long-term impact of unruptured aneurysms on lifetime quality of life are still unknown. ⋯ Lifetime effects of small unruptured aneurysms without risk factors increasing the probability of rupture are relatively small, and most patients were expected to die of diseases other than subarachnoid hemorrhage.
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Comparative Study
Short-term Outcome of Clipping vs. Coiling of Ruptured Intra-Cranial Aneurysms Treated by Dual-Trained Cerebrovascular Surgeon: Single Institution Experience.
Studies that showed endovascular coiling of ruptured intracranial aneurysms (RAs) to be superior to microsurgical clipping have compared dedicated endovascular interventionists versus open cerebrovascular surgeons. This is the first study to evaluate outcomes of coiling versus clipping of RAs treated by a dual-trained cerebrovascular surgeon using a specific intervention protocol. ⋯ RA treatment should be individualized, with clipping and coiling being 2 complementary arms. Assessment of patient and aneurysm characteristics along with the advantages of both techniques provides an optimal therapeutic modality.