World Neurosurg
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Intracranial arteriovenous malformations (AVMs) are congenital lesions frequently diagnosed as a result of hemorrhage or other neurological symptoms. Prevention of such devastating neurological injury has promoted a variety of treatment strategies. The rich history of multimodal therapy in the treatment of AVMs includes microsurgery, endovascular embolization, and stereotactic radiosurgery (SRS). ⋯ It considers various paradigms and goals of endovascular treatment, along with relevant issues such as the features of an AVM to be targeted. Issues of the interplay between SRS and endovascular neurosurgery include the compartments of an embolized AVM to contain within the radiosurgery plan, the radioprotective and radiosensitizing effects of the embolic agent, the durability of embolization, and the sequencing of embolization with respect to the radiosurgical treatment. Published literature on these topics is sparse, and the flimsiness of the data offers limited guidance.
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To study the indication for reoperations after lumbar decompression, the factors predisposing to redo operations, and the effect of prior instrumentation on developing adjacent level stenosis requiring reoperation. ⋯ Many patients with spinal stenosis undergo instrumentation because of instability. Most patients in this study underwent reoperation at the same level, and the most common pathology was spinal stenosis. The risk of reoperation was lower in older patients (≥65 years old). Although there was a trend that the risk of reoperation was higher among patients with prior instrumentation, it did not reach statistical significance. In this study, there was no association between prior instrumentation and adjacent level stenosis requiring reoperation. These findings need to be evaluated further in randomized trials.
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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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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.
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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.