World Neurosurg
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Randomized Controlled Trial Comparative Study
A randomized controlled trial comparing the outcome of burr-hole irrigation with and without drainage in the treatment of chronic subdural hematoma: a preliminary report.
Burr-hole is the most frequently used neurosurgical treatment for chronic subdural hematoma (CSDH). Few data can be found in the literature confirming the impact of using drainage after evacuation and irrigation of the cavity containing CSDH on the outcome of the patients. It is not clear whether installing such a drainage system would reduce the recurrence rate. ⋯ Type of surgical technique does not seem to be a main variable improving the outcome of such patients and may act as a confounding factor. Age, neurological status, and comorbidities seem to have more significant impact upon the surgical outcome.
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To define and grade neurosurgical and spinal postoperative complications based on their need for treatment. ⋯ The authors present a simple, practical, and easy to reproduce way to report negative outcomes based on the therapy administered to treat a complication. The main advantages of this classification are the ability to compare surgical results among different centers and times, the ability to compare medical and surgical complications, and the ability to perform future meta-analyses.
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To present our initial experience with the Elekta eXtend System, a relocatable frame system for multiple-fraction or serial multiple-session radiosurgery. ⋯ Gamma Knife radiosurgery (GKRS) has traditionally been a single-fraction treatment modality. The eXtend System expands the range of indications for GKRS to those that may benefit from multi-fraction or serial multi-session techniques. The relocatable eXtend frame can provide non-invasive head fixation while maintaining a high accuracy, high dose, and the steep gradients associated with GKRS.
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To review a series of patients who underwent Gamma Knife surgery (GKS) to identify prognostic factors for local growth control and survival. ⋯ GKS for melanoma brain metastasis provides a high rate of local tumor control. Survival is longest for well-functioning patients with absence of extracranial metastases or with an intracerebral total tumor volume less than 5 cc.
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Brain abscess (BA) is a neurosurgical emergency and despite significant medical advances, it remains a surgical challenge. A single institution's two decade computed tomography era management experience with BA is reported. ⋯ Optimal management of BA involves surgical drainage for medium-to-large abscesses (≥2.5 cm) with simultaneous eradication of the primary source, treatment of associated hydrocephalus, and administration of high doses of intravenous antibiotics. The incidence of BA is directly related to poor socioeconomic conditions and therefore, still poses a public health challenge in developing countries.