World Neurosurg
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Accurate measurement of surgical outcomes is highly desirable to optimize surgical decision-making. An important element of surgical decision making is identification of the patient cohort that will benefit from surgery before the intervention. Machine learning (ML) enables computers to learn from previous data to make accurate predictions on new data. In this systematic review, we evaluate the potential of ML for neurosurgical outcome prediction. ⋯ In the research setting, ML has been studied extensively, demonstrating an excellent performance in outcome prediction for a wide range of neurosurgical conditions. However, future studies should investigate how ML can be implemented as a practical tool supporting neurosurgical care.
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Surgical treatment of patients with atlantoaxial instability caused by pathologic changes of the skull base and craniovertebral junction combined with anterior compression of the brain stem is still associated with substantial technical difficulties and remains a matter of debate. Currently, anterior stabilization of the atlantoaxial junction is a promising approach that allows for the resection of the pathologic lesion of the skull base and craniovertebral junction with subsequent stabilization of C1-C2 or C1-C3 in 1 stage. ⋯ The first experience of anterior fixation using individually manufactured C1-C2 and C1-C3 systems demonstrated their effectiveness. This approach can be safely used as an alternative or in combination with standard posterior stabilization methods. An innovative surgical technology developed and implemented in our surgical practice allows for optimization of the surgical technique, reduces the number of perioperative complications, eliminates movement restrictions in the cervical spine, improves motor activity, and makes earlier patient rehabilitation possible.
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Review Comparative Study
A systematic review of radiosurgery versus surgery for neurofibromatosis type 2 vestibular schwannomas.
Neurofibromatosis type 2 (NF2) is an autosomal dominant disease characterized by bilateral vestibular schwannomas (VSs). NF2-associated VSs (NF2-VSs) are routinely treated with microsurgery; however, stereotactic radiosurgery (SRS) has emerged as an effective alternative in recent decades. To elucidate the role of SRS in NF2-VSs, a systematic review of the literature was conducted to compare outcomes of SRS versus surgery. ⋯ SRS appears to be a safe and effective alternative to surgery for NF2-VS. Although rates of hearing preservation were higher in the surgery cohorts, SRS demonstrated high rates of local control and significantly lower facial nerve complications. Certain patients may therefore benefit more from SRS than surgery.
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Perioperative complications after transsphenoidal surgery for pituitary adenomas have been well documented in the literature; however, some complications can occur in a delayed fashion postoperatively, and reports are sparse about their occurrence, management, and outcome. Here, we describe delayed complications after transsphenoidal surgery and discuss the incidence, temporality from the surgery, and management of these complications based on the findings of studies that reported delayed postoperative epistaxis, delayed postoperative cavernous carotid pseudoaneurysm formation and rupture, vasospasm, delayed symptomatic hyponatremia, hypopituitarism, hydrocephalus, and sinonasal complications. ⋯ Sinonasal complications are commonly reported after transsphenoidal surgery, but spontaneous resolutions within 3-12 months have been reported. Although the incidence of some of these complications is low, providing preoperative counseling to patients with pituitary tumors regarding these delayed complications and proper postoperative follow-up planning is an important part of treatment planning.
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Natalizumab, a selective adhesion molecule inhibitor binding to an α-4 subunit of integrin, has emerged to be an effective immunomodulator, especially in the treatment of relapsing-remitting multiple sclerosis and Crohn disease. Recent reports documenting the development of primary central nervous system lymphoma (PCNSL) as a result of its administration have been concerning, and they trigger a debate about a possible causal association. In our report, we provide a comprehensive review of the literature on lymphoma development after natalizumab use, and we report an additional case of PCNSL development in a young woman who received natalizumab for her Crohn disease. ⋯ Evidence documenting a causal association of natalizumab and PCNSL is weak. Considering the potential benefits of using natalizumab for current indications, we recommend vigilant monitoring of patients receiving the drug for PCNSL outlook.