World Neurosurg
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Medical research is increasing in complexity with every year. The breadth of possibilities is expanding with every new methodologic and statistical innovation. ⋯ Lately, owing to serious improvements made to study design quality, the neurosurgical evidence base is growing. The special section on neurosurgical study design highlights the most important methodologic concepts to date and illustrates the most important methodologic advancements, which will shape the future of neurosurgical study design.
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There is lack of consensus regarding optimal adjuvant therapy in elderly glioblastoma (GBM). We have been treating elderly (≥60 years) GBM patients with normofractionated or hypofractionated radiotherapy (RT) plus temozolomide (TMZ) based on Karnofsky performance status (KPS). Herein we report clinical outcomes in this cohort treated at our institute using this approach. ⋯ Our single-institution clinical audit confirms poor survival in elderly GBM with suboptimal performance status but demonstrates acceptably fair outcomes in patients with preserved KPS comparable with the nonelderly cohort.
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Regression analysis quantifies the relationships between one or more independent variables and a dependent variable and is one of the most frequently used types of analysis in medical research. The aim of this article is to provide a brief theoretical and practical tutorial for neurosurgeons wishing to conduct or interpret regression analyses. ⋯ Regression analysis is a powerful and versatile instrument in data analysis. This material is intended as a starter for those wishing to critically interpret or perform regression analysis and we recommend multidisciplinary collaborations with trained methodologists, statisticians, or epidemiologists.
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A 32-year-old woman presented with chronically progressive spastic quadriparesis. Detailed clinicoradiological evaluation led to the diagnosis of irreducible atlantoaxial dislocation and basilar invagination, with associated "kissing" carotids and an anomalous right vertebral artery (VA). Both internal carotid arteries had an abnormally tortuous course, "kissing" retropharyngeally at the level of C1-C2. ⋯ Despite the deformed joints and the possibility of injuring the anomalous right VA during C2-C3 instrumentation, a tailored posterior-only approach was used to circumvent the arterial fence created by both vascular anomalies. The patient underwent bilateral C1-C2 joint opening and left C1-C2 joint spacer placement, followed by bilateral occipito-C3-C4 fixation. This is possibly the first reported case of a complex craniovertebral junction anomaly associated with both kissing carotids and a C3 segmental VA.
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Glioblastoma (GB) is an aggressive tumor showing extensive intertumoral and intratumoral heterogeneity. Several possible reasons contribute to the historical inability to develop effective therapeutic strategies for treatment of GB. One such challenge is the inability to consistently procure high-quality biologically preserved specimens for use in molecular research and patient-derived xenograft model development. No scientifically derived standardized method exists for intraoperative tissue collection specifically designed with the fragility of RNA in mind. ⋯ Our results showed that primary GB cell cultures derived in this manner had improved growth over widely used collection and preservation methods. By implementing an automated intraoperative system, we also eliminated inconsistencies in methodology of tissue collection, handling and biological preservation, establishing a repeatable and standardized practice that does not require additional staff or a laboratory technician to manage it.