World Neurosurg
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Recent approval of unprecedented gene therapies has signaled the beginning of a new era in modern medicine. This rapidly changing landscape underscores the importance of neurosurgeons developing a fundamental understanding of gene therapy, because many neurologic disorders are caused by derangements in gene expression. ⋯ There are several methods to transfer genetic material to the nervous system through viral transduction. Here, we synthesize the latest developments in gene therapy for neurologic disorders and the neurosurgical approaches to treat them.
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Multicenter Study Observational Study
Cranioplasty with porous hydroxyapatite custom-made bone flap: results from a multi-centre study enrolling 149 patients over 15 years.
Despite the mixed evidence regarding the effect of decompressive craniectomy in terms of outcome, a tremendous increase in related reports has been observed in the last years. Cranioplasty plays a key role in restoring function and anatomy of the cranial vault. Considering that cranioplasty is not exempt from risks, the identification of the safest technique becomes crucial to achieve better patients' recovery. Porous hydroxyapatite (PHA) has received growing attention for its potential in bony integration. Here we report a multicenter prospective follow-up analysis of 149 patients who underwent cranioplasty with PHA prostheses. In particular, we focus on the incidence of adverse events and implant removal. ⋯ Hydroxyapatite for cranial implants is fully comparable to other heterologous materials. It has a biologic potential of bony integration. The risk of explants seems to be significantly higher in second-line patients, data not shown in previous studies.
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Both stereotactic radiosurgery (SRS) and fractionated radiation therapy (FRT) techniques are used for treatment of intracranial meningiomas with excellent local control (LC) rates. Although SRS techniques are convenient, toxicity including treatment-related edema can significantly impact patient quality of life. The long-term clinical outcomes of patients with magnetic resonance imaging (MRI)-defined meningiomas treated with radiation therapy (RT) alone are reported. ⋯ RT alone using a limited margin is an effective treatment option for MRI-defined meningiomas and should be considered even without biopsy if surgery will present significant morbidity. Although LC with SRS versus FRT was comparable, FRT was associated with a significantly decreased risk of TRE.
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Multicenter Study Observational Study
Quality of life after treatment of unruptured intracranial aneurysms.
Quality of life is an important factor in the decision making for the treatment of unruptured intracranial aneurysms (UIA). The data dealing with QoL in patients after the treatment are spare. We have evaluated QoL of patients after endovascular or surgical treatment of incidental intracranial aneurysm. ⋯ The risk for depression and pain is not significantly increased after elective treatment of UIA. According to our results, decreased QoL is common in this cohort of patients but often related to factors not associated with aneurysm treatment.
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This meta-analysis aimed to evaluate the risk of shunt-dependent hydrocephalus among patients with ruptured intracranial aneurysms treated with either coil placement or clipping. ⋯ Microsurgical clipping and endovascular coiling of ruptured cerebral aneurysms are associated with similar incidences of ventricular shunt placement for hydrocephalus. The risk of shunt-dependent hydrocephalus is not higher after coiling than after clipping of ruptured intracranial aneurysms.