World Neurosurg
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Modern glioma surgery has evolved from the principal belief that safe, maximal tumor resection improves symptom management, quality of life, progression-free survival, and overall survival in both low-grade and high-grade glioma. However, in the absence of level I data, the overwhelming support for this idea is derived largely from retrospective series. As a result, the influence of increasing extent of resection and reducing tumor burden on the efficacy of postoperative chemotherapy and radiotherapy, and survival, remains inadequately defined. ⋯ Important new technologies have been developed concurrently to mitigate neurologic risks related to the pursuit of maximizing extent of resection. These advances reflect the modern goal of glioma surgery to find the optimal balance between tumor removal and neurologic compromise. We review the current literature supporting safe, maximal resection for gliomas.
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Cerebral ischemia is a major contributor to poor outcome after ruptured anterior communicating artery aneurysms (ACoAs), and is not well classified. In this article, we develop a classification and identify risk factors of cerebral ischemia after ruptured ACoAs. ⋯ Male sex and higher Fisher grade predict postoperative ischemia (grade I-IV), whereas surgical timing does not. However, in patients with postoperative cerebral ischemia, early surgery within 3 days and age greater than 55 years can increase the frequency of postoperative neurological deficits (grade III-IV). Older male patients undergoing early microsurgery had a tendency to develop neurologic deficits.
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Review Meta Analysis
Cranioplasty infection and resorption are associated with presence of a ventriculoperitoneal shunt: A systematic review and meta-analysis.
Following decompressive craniectomy, hydrocephalus is a common complication often necessitating placement of a ventriculoperitoneal shunt (VPS). Complications in the presence of a VPS have been reported, but a clear association has not been established. ⋯ Cranioplasty in the presence of a VPS is associated with a higher rate of overall complications, including infection and bone resorption. Performing cranioplasty and VPS placement in the same operation is associated with an increased rate of complications compared with staged procedures. Surgeons should consider staging these procedures when possible and counsel patients about these risks.
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This anatomic image demonstrates the sphenoethmoidal (Onodi) cell (a variant of the paranasal sinuses), the identification of which is critical to prevent neurovascular injury during endoscopic approaches to the sella and adjacent regions of the skull base.
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Flow diverter stents (FDS) are a recognized treatment option for intracranial aneurysms. There remain ongoing concerns regarding the safety of FDS, especially regarding the fate of covered side branches. We report the patency of side branches covered by FDS. ⋯ The side branch occlusion rate was 20% and included ophthalmic, posterior communicating, and anterior cerebral arteries. Consistent with other studies, we did not see occlusion of the anterior choroidal artery.