World Neurosurg
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Stereotactic radiosurgery (SRS) is a form of radiation therapy that delivers a focused, highly conformal dose of radiation to a single volume, while minimizing damage to the adjacent nervous tissue. The efficacy of SRS has been examined in the treatment of patients diagnosed with brain metastases due to the fact that it is capable of targeting any region in the brain and can irradiate multiple tumors in the same treatment setting in a noninvasive fashion. ⋯ SRS can be an advantageous course of treatment in specific patient groups when utilized alone, after surgery, with WBRT, or in combination with either or both of the treatment modalities. Although treatment approaches have been refined, many questions remain unanswered and further clinical evidence is needed to guide physicians in their future treatment decisions regarding treating patients in specific clinical scenarios.
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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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We sought to assess general aspects of endovascular neurosurgery training, practice, and management for the treatment of intracranial aneurysms, arteriovenous malformations, acute ischemic stroke, and extracranial or intracranial occlusive disease within neurosurgery training and practice in the United States. ⋯ Our findings provide a snapshot of current neurosurgical endovascular practices in the United States.
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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 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.