World Neurosurg
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Comparative Study
Superior efficacy of gross total resection in anaplastic astrocytoma patients relative to glioblastoma patients.
Because of their relative rarity, anaplastic astrocytomas (AAs) often are grouped with glioblastomas in clinical treatment paradigms. There are reasons, however, to expect that the therapeutic response of AAs may differ from those of glioblastoma. Here, we examined the clinical benefit of gross total resection (GTR) in AA relative to glioblastoma patients. ⋯ The Surveillance, Epidemiology and End Results data suggest that survival benefit associated with GTR was greater for patients with AA relative to glioblastoma patients, particularly for patients < age 50.
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The complex structure around the upper cervical spine makes surgical treatment difficult. the present study aimed to analyze how patients with ossification of the longitudinal ligament (OPLL) involving the C2 were managed and to compare the surgical outcomes according to the C2 involvement. ⋯ Both of C2 involvement from OPLL and surgery including the C2 did not affect clinical outcomes. The posterior decompressive surgery is safer and more effective than the anterior approach regarding the development of surgery-related complications.
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Intradural extramedullary spine tumors, approximately one-half of which are peripheral nerve sheath tumors (PNSTs), comprise two-thirds of primary spinal neoplasms. Given the rarity of PNSTs and the restricted indications for adding fusion to laminectomy for tumor resection, analyses of spinal fusion outcomes are limited. ⋯ In this cohort, PNSTs in the cervical spine, spanning the cervicothoracic junction, and extradural tumors were associated with higher rates of spinal fusion. Fusion was not associated with new or worsening motor/sensory deficits, CSF leak, pseudomeningocele, wound infection, or spinal deformity. Overall, spinal fusions were well tolerated and did not increase the risk of postoperative complications.
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To share our experience with a new delivery system for the flowable hemostatic matrix, FloSeal, in endoscopic and microscopic skull base surgery. ⋯ Our results indicate that our delivery device of FlowSeal can effectively control hemostasis by applying small amounts of FlowSeal to the site of bleeding. This results in increased visibility during hemostasis and a reduction of cost.
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In this study, we validate the utility of navigation in intracranial meningioma excision and evaluate the effectiveness of image guidance surgery based on clinical outcome, extent of resection, and recurrence-free survival (RFS). ⋯ Interactive surgical navigation is a useful tool in the operative management of intracranial meningiomas to decrease recurrence rate, blood loss, and length of stay, and to improve RFS and performance status. Therefore, use of neuronavigation should be ensured during resection of intracranial meningiomas.