World Neurosurg
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Our purpose is to describe a method of resecting occipital pole gliomas through a keyhole lobectomy and share the patient outcomes of this technique. ⋯ Our study provides details on the technical aspects of occipital keyhole lobectomies and gives the outcomes of patients who have received an operation for tumors in this uncommon location. Taking white matter tract anatomy into consideration, we show that the keyhole method can be applied to gliomas of the occipital lobe.
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The optimal management of pituitary apoplexy (PA) remains debated. The aim of this study was to assess the outcome of the transsphenoidal approach for PA in a large surgical experience. ⋯ The endoscopic endonasal approach represents a valid, effective, and safe technique in the management of PA. Favorable outcomes can be achieved by referring patients to dedicated pituitary centers with a multidisciplinary team. Further studies are still needed to define criteria for surgical indication and to identify outcome predictors.
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Gliosarcoma is a rare tumor of the central nervous system with a reported incidence of ∼2%-8% of all gliomas. We reviewed the outcomes of patients treated at our institution over a 14-year period from 2000 to 2013 to characterize overall survival (OS) and progression-free survival as well as to elucidate the additive effect of chemoradiotherapy. ⋯ Despite an overall poor prognosis, a multimodality approach aiming for complete resection followed by radiotherapy and chemotherapy appears to be associated with better outcomes.
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The use of an external ventricular drain is required for the treatment of many diseases, such as traumatic brain injury and subarachnoid hemorrhage (SAH). Meningitis and ventriculitis are frequent complications arising from the use of external ventricular drain therapy. This study aimed to determine the sensitivity, specificity, and cutoff point for cell index (CI) in patients with traumatic brain injury, SAH, and hemorrhagic stroke. ⋯ Therefore, CI is valuable for the diagnosis of infection, but was inadequate for monitoring treatment. We hope to use the new cutoff point proposed by this study in our institution to improve patient clinical outcome.
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Endovascular coil embolization and craniotomy with clip ligation are the 2 most commonly used treatments for ruptured cerebral aneurysm. Although coiling maintains the advantages of brevity and complete avoidance of brain retraction and manipulation, clipping offers the benefits of decompression of the injured brain and lower rates of aneurysm recurrence. A combined, immediately sequential treatment strategy for acutely ruptured cerebral aneurysm that simultaneously maximizes the advantages of both techniques, while minimizing their respective disadvantages, may be a useful paradigm. ⋯ A deliberate combined treatment strategy that uses clipping immediately preceded by subtotal coiling under a single anesthetic may be ideal for selected ruptured cerebral aneurysms, takes advantage of the unique strengths of both techniques, makes both techniques easier, and maximizes opportunity for brain protection against delayed complications in the prolonged aftermath of aneurysmal subarachnoid hemorrhage.