World Neurosurg
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From Luessenhop's early clinical experience until the present day, experimental methods have been introduced to make progress in endovascular neurosurgery. ⋯ We must learn how to safely practice endovascular neurosurgery in the presence of uncertainty and verify patient outcomes in real time.
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Multicenter Study Comparative Study
Image guidance for the placement of Ommaya reservoirs: A comparison of fluoroscopy and frameless stereotactic navigation in 145 patients.
Ommaya reservoirs are used for administration of intrathecal chemotherapy and cerebrospinal fluid sampling. Ventricular catheter placement for these purposes requires a high degree of accuracy. Various options exist to optimize catheter placement. We analyze a cohort of patients receiving catheters using 2 different technologies. ⋯ Ommaya reservoirs can be placed accurately using different methods. Although there are slight differences between fluoroscopy and frameless stereotaxy in quantitative accuracy and procedure time, there is no significant advantage of 1 method over the other when evaluating revision or complication rates. Technique familiarity and surgeon preference may dictate the preferred procedure.
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Case Reports Multicenter Study
Pipeline Embolization Device for Recurrent Cerebral Aneurysms after Microsurgical Clipping.
Microsurgical clipping is regarded as the most durable treatment for cerebral aneurysms. Aneurysm recurrence after clipping is uncommon and is associated with an increased risk of rupture. Reoperation for recurrent cerebral aneurysms is particularly challenging because of adhesions and scaring, and it carries a higher rate of morbidity and mortality. Pipeline embolization as a treatment option for recurrent aneurysms has rarely been reported. ⋯ PED for recurrent aneurysms after clipping may be a feasible alternative to reoperation. In our experience, treatment with PED for these aneurysms is safe and efficacious.
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Surgery for cranial and spinal tumors has evolved tremendously over the years. Not only have neuro-oncologists been able to better understand tumor biology and thereby improve multimodality therapy, but advances in surgical techniques have also directly equipped neurosurgeons with the armamentarium necessary to achieve more radical resections safely. Intraoperative imaging tools are one such adjunct. Though intraoperative magnetic resonance (MR) has emerged as the "gold standard" among these, logistical challenges make it difficult to implement across all centers. On the other hand, the use of ultrasound (US) intraoperatively predates the use of MR. Over the past 4 decades, technologic improvements have refined and expanded the scope and application of intraoperative US technology. Strategies to maximize its efficacy and overcome the various limitations have evolved. A large volume of clinical experience has accumulated with respect to its role as an adjunct specifically in tumor surgery. ⋯ IOUS is a powerful and versatile multipurpose intraoperative adjunct in tumor surgery, especially for resection control. The learning curve is relatively easy to climb and future improvements in technology are likely to widen the scope of its use.
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Medulloblastoma is the most common malignant brain tumor in children. Infants are in the high-risk category. Complete surgical resection is the single most important determinant of prognosis and survival in nonmetastatic disease. Infants with large primaries after incomplete resection/biopsy and poor general condition have bad prognosis. They are considered poor candidates for intensive chemotherapy involving high dose methotrexate/autologous stem cell transplantation as they are often unable to tolerate these aggressive regimens. ⋯ We suggest that the role of neoadjuvant chemotherapy should be explored in patients with infantile medulloblastoma in whom upfront complete resection is not possible, considering the gratifying results obtained in our case.