World Neurosurg
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Brain metastases occur in 10%-40% of patients with cancer and are more common than primary brain tumors (30%-40%); their incidence is growing because of improvements in control of systemic disease, better radiologic detection, and prolonged survival. Modern treatment of brain metastases has dramatically changed the expected prognosis. Traditionally, the prognosis has been considered very poor, and patients were referred to palliative treatment because of their terminal stage; however, new prognostic indexes have been proposed to evaluate these patients. The aim of our study was to determine the long-term effect of surgery on overall survival (OS) in patients with brain metastases from dissimilar primary tumors and to identify prognostic variables associated with prolonged survival. ⋯ Surgery is a safe and effective procedure for cerebral metastases and should not be considered an aggressive treatment in such disease. In our series, 55% of patients had a survival >6 months and a significant improvement in terms of actual versus expected survival. Surgical resection should be considered the primary option for patients with brain metastases.
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Review Case Reports
The Role of Intraoperative Cerebral Angiography in Transorbital Intracranial Penetrating Trauma: A Case Report and Literature Review.
Transorbital intracranial penetrating trauma with a retained intracranial foreign body is a rare event lacking a widely accepted diagnostic and therapeutic algorithm. Intraoperative catheter angiography (IOA) has been advocated by some authorities to rule out cerebrovascular injury before and/or after removal of the object, but no standard of care currently exists. ⋯ In transorbital intracranial penetrating trauma with a retained intracranial object, we advocate microsurgical removal of the object under direct visualization followed immediately by IOA. IOA should be strongly considered even in the setting of minimal intraoperative bleeding and normal findings on videoangiography (a course of action that was not followed in the present case). Given that CT angiography and intraoperative videoangiography may miss a potentially treatable traumatic arterial injury, IOA can help determine whether cerebral revascularization may be necessary.
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To describe the topographic anatomy of surgically accessible surfaces of the human thalamus as a guide to surgical exploration of this sensitive area. ⋯ Observations from this study supplement current knowledge, advancing the capabilities to define the exact topographic location of thalamic lesions. This improved understanding of anatomy is valuable when designing the most appropriate and least traumatic surgical approach to thalamic lesions. These proposed surface divisions, based on recognizable anatomic landmarks, can provide more reliable surgical orientation.
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Review Case Reports
Upfront Gamma Knife Surgery for Giant Central Neurocytoma: Two case studies.
In this report, we present the results of using upfront Gamma Knife surgery (GKS) in the management of giant central neurocytoma (CNC) (volume >50 mL) without the initial removal of the tumor mass. ⋯ Based on this initial experience, it appears that GKS is an effective treatment for CNC and may be used for upfront management in cases of indolent clinical symptoms, even when the tumor is very large.
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Multicenter Study
Neurosurgical Infection Rates and Risk Factors: A NSQIP Analysis of 132,000 Patients, 2006-2014.
The existing body of literature on postoperative neurosurgical infections lacks large multicenter reports on postoperative neurosurgical infections. This is the largest study to date of postoperative neurosurgical infections rates, time to event, and risk factors. ⋯ The overall ACS-NSQIP reported rate of postoperative infections was 5.3% from 2006 to 2014. Multivariable analysis demonstrated several predictive factors for postoperative infections.