World Neurosurg
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Gross total resection for glioblastoma (GBM) has been associated with better prognosis. However, it is not always feasible, and the threshold for the extent of resection required for better prognosis has been controversial. Therefore, we compared the survival and clinical outcomes of patients with GBM who had undergone partial resection (PR) or biopsy. ⋯ PR failed to improve survival compared with biopsy for patients with GBM. Moreover, the surgical complication rate in the PR group was greater than that in the biopsy group.
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Cervical spondylotic amyotrophy (CSA) is not common. The clinical features and long-term surgical outcomes of patients with CSA are also unclear. We sought to summarize clinical features, assess long-term surgical outcomes, and determine the prognostic factors relevant for patients with CSA. ⋯ Besides significant muscular atrophy in one upper extremity, CSA also occasionally presents with mild atrophy in the other upper extremity, sensory disturbance in the upper extremities, or hyperflexia in the lower extremities. Anterior decompression is generally effective in the treatment of patients with CSA. Preoperative duration of symptoms, type of CSA, and ossification of the posterior longitudinal ligament are important predictors for the surgical outcome.
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Few studies have been published about percutaneous techniques for management of surgical bed hemorrhage during a stereotactic biopsy, a serious complication that may affect patient outcome. We describe the injection of a thrombin-gelatin matrix through the biopsy cannula as an effective method to arrest surgical bed bleeding that does not respond to conventional methods of hemostasis. ⋯ Our preliminary results suggest that thrombin-gelatin matrix injection is a simple, safe, and effective stereotactic practice to manage persistent surgical bed bleeding that cannot be arrested by standard, conventional hemostatic methods.
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Anterior temporal lobectomy (ATL) is the most common surgical procedure for refractory temporal lobe epilepsy. When scalp electroencephalography cannot adequately identify an epileptogenic site, electrode implantation may be used to monitor epileptic activity and localize a target focus before surgical resection. Whether the advantage of improved seizure localization justifies the added risk of electrode placement remains unclear. : The present study uses an international surgical database to explore whether a 2wo-stage approach, electrode implant followed by ATL, has a reasonable safety profile and is clinically worthwhile versus ATL alone. ⋯ Intracranial electrode placement increases the risk of complications when added to ATL. The severity of complications from electrode placement are mild, however, and as intracranial electrode recording provides a potentially large reduction in the surgical failure risk, electrode placement may be advisable for all but the most convincing seizure foci.
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Hypnosis is a technique that could aid awake surgery protocols. The aim of the present study is to describe the results of a preliminary experience of a cohort of patients operated on with an original protocol of hypnosis-aided awake surgery (HAS). ⋯ According to the results, hypnosis-aided resection of intrinsic brain tumor located in eloquent areas is safe and effective, although dissociation phenomena deserve further investigation to be completely understood.