World Neurosurg
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As the population ages, the proportion of elderly patients with glioblastomas has increased. Recently, many researchers have focused on the treatments available to and prognoses in elderly patients with glioblastomas. ⋯ Maximal safe surgical resection followed by radiotherapy with concurrent and adjuvant temozolomide significantly prolonged overall survival times and was well tolerated in elderly patients with glioblastomas. In addition, low p53 protein expression was a significant favorable prognostic indicator in this population.
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Meningiomas are common intracranial tumors that can have a complex arterial supply. In a patient with a recurrent large left clinoid aypical grade 2 meningioma, diagnostic angiography revealed left proximal middle cerebral artery (MCA) occlusion and reconstitution of the MCA circulation from the left middle meningeal artery. Consequently, the planned surgical approach was adjusted to preserve the left external carotid artery circulation in a difficult meningioma resection. This case illustrates a role for preoperative angiography in surgical planning of patients with complex skull base tumors involving intracranial vascular structures and highlights the unique neovascularization that often occurs as meningiomas parasitize the exracranial blood supply.
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Posterior cervical foraminotomy is a valuable option as a treatment for cervical radiculopathy caused by osseous foraminal stenosis. Here the authors present their technique and results in a series of patients with and without previous surgery. ⋯ This retrospective analysis shows that microendoscopic posterior cervical foraminotomy is a successful option in the treatment of osseous cervical foraminal stenosis. Nevertheless, clinical success in patients with previous surgery is much lower compared with patients without previous surgery. Thus, a more thorough clinical workup is recommended to identify the patients who are not going to benefit before subsequent surgical procedures.
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Trigeminal neurovascular contact (NVC) is hypothesized to be the etiology of classical trigeminal neuralgia (TGN). We aimed to seek a correlation between types of NVCs and the presence of TGN as well as early surgical outcome in patients with TGN treated with trigeminal microvascular decompression (MVD). ⋯ We conclude that in TGN patients treated with MVD, magnetic resonance imaging identified neurovascular compression at the root entry zone (correlates with the affected side and early postoperative pain relief.
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Here, we compare the angiographic characteristics of hemorrhagic and nonhemorrhagic hemispheres within the same adult patient with moyamoya disease (MMD) and identify the possible risk factors for initial and recurrent hemorrhage during the long-term follow-up period. ⋯ Compared with the nonhemorrhagic hemispheres, hemorrhagic hemispheres are more prone to recurrent hemorrhage. Our case-control study showed the dilation of the anterior choroidal artery or posterior communicating artery, as well as the involvement of the posterior cerebral artery, is associated with the initial hemorrhage of MMD, but not for the episode of recurrent hemorrhage. Longer and more detailed clinical and angiographic follow-up are still needed to delineate the specific mechanism underlying the recurrent hemorrhage in hemorrhagic MMD.