1
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The Interpeduncular Fossa Approach for Resection of Centromedian Midbrain Lesions. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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2
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The Superior Fovea Triangle Approach for Dorsal Pontine Lesions at the Level of the Facial Colliculus. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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3
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Long-Term Facial Nerve Outcomes Following Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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4
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Abstract
The unique challenges inherent to microneurosurgery demand that we stay on the forefront of new surgical technologies. Many believe the next major technological advance in neurosurgery will be the widespread application of image-guided robotics in the operating room. We evaluated a novel technology for image-guided robotic auto-navigation of the operating microscope in a prospectively enrolled cohort of patients. Twenty patients were prospectively enrolled for analysis. Data were collected on the extent of resection, operative time, estimated blood loss, time taken to set up the new software, and complications encountered. Software accuracy, reliability, and usefulness in the case were subjectively evaluated. The most commonly treated pathologies were cavernous malformation (n = 5), arteriovenous malformation (n = 4), and meningioma (n = 4). The time to set up the new software interface before the start of the operation was <60 seconds in all cases. Subjective evaluation in each case revealed the robotic interface to be accurate, reliable, and useful. The new technology was significantly more useful in deeper lesions. The addition of image-guided robotic auto-positioning features to the operating microscope has a great potential to advance the field of neurosurgery. This study is the first prospective evaluation of such a technology in a patient cohort. The results suggest that the newest robotic auto-positioning technology has the potential to improve the neurosurgeon's efficiency and efficacy, thereby positively impacting patient safety and surgical outcomes, especially in cases involving deep-seated lesions.
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5
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The Anterolateral Limit of the Occipital Lobe: An Anatomical and Imaging Study. Skull Base Surg 2016; 77:491-498. [DOI: 10.1055/s-0036-1584093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/29/2016] [Indexed: 10/21/2022]
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6
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Meta-analysis Comparing Continuous and Intermittent Cerebrospinal Fluid Drainage in Aneurysmal Subarachnoid Hemorrhage. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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7
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Bleeding Risk versus Thromboembolic Risk in Patients Undergoing Posterior Fossa Skull Base Surgery in the Modern Era: Results of an Aggressive Chemical Vte Prophylaxis Paradigm. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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8
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Risk Factors for Shunt Dependency after Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis including 25 Years of Data. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1580084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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9
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Cystic Vestibular Schwannomas have Similar Surgical Outcomes and Recurrence Rates as Solid Vestibular Schwannomas. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Long-term Survival after Resection of HER2+ Infiltrating Ductal Carcinoma Metastasis to the Brainstem. Cureus 2016; 8:e462. [PMID: 26929889 PMCID: PMC4762768 DOI: 10.7759/cureus.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The central nervous system is a common site of metastatic spread from neoplasms in distant organs, including breast, bone, and lung. The decision to surgically treat these metastatic lesions is often challenging, especially in the setting of systemic disease or when eloquent brain regions are involved. Treating metastatic disease in the brainstem can be technically difficult, and in many institutions, considered a contraindication to surgical intervention, given the relatively high risk of new postoperative neurological deficits. Herein, we report a case of metastatic ductal carcinoma of the breast with spread to the pontine-medullary junction that was treated with aggressive surgical resection and chronic hormonal therapy. After surgical excision of the brainstem lesion, the patient remained asymptomatic and was maintained on trastuzumab therapy over a 10-year follow-up period, with no radiographic or clinical evidence of recurrent disease. To our knowledge, this is the first report of a patient treated for a solitary metastasis to the brainstem with long-term survival.
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Extracellular RNAs: development as biomarkers of human disease. J Extracell Vesicles 2015; 4:27495. [PMID: 26320940 PMCID: PMC4553262 DOI: 10.3402/jev.v4.27495] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/08/2015] [Accepted: 07/08/2015] [Indexed: 12/31/2022] Open
Abstract
Ten ongoing studies designed to test the possibility that extracellular RNAs may serve as biomarkers in human disease are described. These studies, funded by the NIH Common Fund Extracellular RNA Communication Program, examine diverse extracellular body fluids, including plasma, serum, urine and cerebrospinal fluid. The disorders studied include hepatic and gastric cancer, cardiovascular disease, chronic kidney disease, neurodegenerative disease, brain tumours, intracranial haemorrhage, multiple sclerosis and placental disorders. Progress to date and the plans for future studies are outlined.
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Meeting report: discussions and preliminary findings on extracellular RNA measurement methods from laboratories in the NIH Extracellular RNA Communication Consortium. J Extracell Vesicles 2015; 4:26533. [PMID: 26320937 PMCID: PMC4553263 DOI: 10.3402/jev.v4.26533] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/17/2015] [Accepted: 05/03/2015] [Indexed: 01/14/2023] Open
Abstract
Extracellular RNAs (exRNAs) have been identified in all tested biofluids and have been associated with a variety of extracellular vesicles, ribonucleoprotein complexes and lipoprotein complexes. Much of the interest in exRNAs lies in the fact that they may serve as signalling molecules between cells, their potential to serve as biomarkers for prediction and diagnosis of disease and the possibility that exRNAs or the extracellular particles that carry them might be used for therapeutic purposes. Among the most significant bottlenecks to progress in this field is the lack of robust and standardized methods for collection and processing of biofluids, separation of different types of exRNA-containing particles and isolation and analysis of exRNAs. The Sample and Assay Standards Working Group of the Extracellular RNA Communication Consortium is a group of laboratories funded by the U.S. National Institutes of Health to develop such methods. In our first joint endeavour, we held a series of conference calls and in-person meetings to survey the methods used among our members, placed them in the context of the current literature and used our findings to identify areas in which the identification of robust methodologies would promote rapid advancements in the exRNA field.
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Radiation Necrosis Secondary to Trigeminal Nerve TomoTherapy: A Cautionary Case Study. Cureus 2015; 7:e243. [PMID: 26180667 PMCID: PMC4494583 DOI: 10.7759/cureus.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 11/05/2022] Open
Abstract
New radiation delivery modalities have recently challenged Gamma Knife surgery as the historic gold standard in the treatment of trigeminal neuralgia (TN). TomoTherapy, a relative newcomer, has been approved by the U.S. FDA for various intracranial pathologies but is currently off label for the treatment of TN. A 73-year-old female presented with gait instability, intermittent headaches, and confusion. She was treated with TomoTherapy for refractory TN at an outside facility, which failed to reduce her symptoms. Magnetic resonance imaging demonstrated a lesion in the right mesial temporal lobe. A standard right anterior temporal lobectomy was performed and the final pathological report was notable for necrosis, gliosis, and edema consistent with a remote radiation injury. The patient improved postoperatively, but at her two-year follow up, she continued to have persistent bilateral TN and new onset seizures. Imaging revealed no new mass in the resection field. Stereotactic radiosurgery (SRS) is an evolving field with broadening indications, which makes it ever more important for physicians to be aware of differences between various SRS modalities. This case report highlights a cautionary example, and emphasizes the need for a more systematic evaluation of novel SRS methods before clinical application.
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14
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E-034 pipeline embolization for endoluminal reconstruction of blister-type carotid aneurysms after failed clip-wrapping. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Classification and Repair of Extensive Anterior Skull Base Fractures. Skull Base Surg 2015. [DOI: 10.1055/s-0035-1546623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Extensive Anterior Cranial Base Fractures: Anatomic and Surgical Description of Combination Flaps. Skull Base Surg 2015. [DOI: 10.1055/s-0035-1546622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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18
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Bypass and Flow Reduction for Unclippable and Uncoilable Vertebrobasilar Aneurysms. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Clinical Characteristics and Long-Term Outcomes in Ruptured Posterior Inferior Cerebellar Artery Aneurysms: A Comparative Analysis. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Onyx Embolization of Carotid Body Paragangliomas: An Adjunct to Safe and Effective Surgical Resection. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Welcome. Interv Neuroradiol 2012. [DOI: 10.1177/15910199120180s101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Stroke, TIA, Amaurosis Fugax, or No Symptoms as Predictors of Outcomes in the Carotid Revascularization Endarterectomy Versus Stenting Trial (S09.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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23
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Extracranial to Intracranial Bypass for Treatment of Complex, Large and Giant Aneurysms of the Middle Cerebral Artery: An Analysis of 27 Years of Experience in 26 Patients. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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24
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Comparative Study of Cranial Topographic Procedures for Determination of Central and Lateral Sulci of the Brain: Putting History to the Test. Skull Base 2007. [DOI: 10.1055/s-2006-958348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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The Anatomy of the Mastoid Emissary Vein and the Venous System of the Posterior Neck Region: Neurosurgical Implications. Skull Base 2007. [DOI: 10.1055/s-2006-958389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Alternative Surgical Approaches in the Treatment of Petroclival Meningiomas. Skull Base 2007. [DOI: 10.1055/s-2006-958314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Unclassified Sarcoma of the Skull Base: Review of 11 Cases. Skull Base 2007. [DOI: 10.1055/s-2006-958382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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28
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Anatomical and Quantitative Description of the Transcavernous Approach for Basilar Artery Aneurysms. Skull Base 2007. [DOI: 10.1055/s-2006-958285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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29
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The Anterior Third of the Sagittal Sinus: Anatomical Study and Neurosurgical Importance. Skull Base 2007. [DOI: 10.1055/s-2006-958292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Trautmann's Triangle and the Transpetrosal Approaches: An Anatomical Study. Skull Base 2007. [DOI: 10.1055/s-2007-981784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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The Anatomy of the Ascending Pharyngeal Artery and Its Implication for Neurosurgical and Endovascular Procedures. Skull Base 2007. [DOI: 10.1055/s-2007-981831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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The Trans-sylvian–Perforator Approach to the Thalamomesencephalic Junction: Technical Note of a New Approach. Skull Base 2007. [DOI: 10.1055/s-2007-981820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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33
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A Quantitative Anatomic and Morphometric Evaluation of the Craniocervical Junction with Specific Regard to the Vertebral Artery and Atlas. Skull Base 2007. [DOI: 10.1055/s-2007-981738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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34
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Comparative Analysis between Retrosigmoid Approach and Lateral Supracerebellar Infratentorial Approaches along the Lateral Surface of the Pontomesencephalic Junction: A Different Perspective. Skull Base 2007. [DOI: 10.1055/s-2007-981785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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35
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A Quantitative Analysis of Working Areas and Angles of Approach to the Posterior Fossa and Petroclival Region via the Retrosigmoid Approach. Skull Base 2007. [DOI: 10.1055/s-2007-981737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Clivus Fibrosis: Natural History of a Benign Condition Mimicking Chordoma. Skull Base 2007. [DOI: 10.1055/s-2007-981817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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37
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A New Classification of Transbasal Approaches. Skull Base 2007. [DOI: 10.1055/s-2007-981707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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38
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Abstract
Object. The goals of this study were to analyze outcomes in patients with posterior fossa ependymomas, determine whether gross-total resection (GTR) alone is appropriate treatment, and evaluate the role of radiation therapy.
Methods. All patients with newly diagnosed intracranial ependymomas treated at Barrow Neurological Institute between 1983 and 2002 were identified. Those with supratentorial primary lesions, subependymomas, or neuraxis dissemination were excluded. Forty-five patients met the criteria for the study. Gross-total resection was accomplished in 32 patients (71%) and subtotal resection (STR) in 13 (29%). Radiation therapy was given to 25 patients: 13 following GTR and 12 after STR. The radiation fields were craniospinal followed by a posterior fossa boost in six patients and posterior fossa or local only in the remaining patients.
With a median follow-up period of 66 months, the median duration of local control was 73.5 months with GTR alone, but has not yet been reached for patients with both GTR and radiotherapy (p = 0.020). The median duration of local control following STR and radiotherapy was 79.6 months. The 10-year actuarial local control rate was 100% for patients who underwent GTR and radiotherapy, 50% for those who underwent GTR alone, and 36% for those who underwent both STR and radiotherapy, representing significant differences between the GTR-plus-radiotherapy and GTR-alone cohorts (p = 0.018), and between the GTR-plus-radiotherapy and the STR-plus-radiotherapy group (p = 0.003). There was no significant difference in the 10-year actuarial local control rate between the GTR-alone and STR-plus-radiotherapy cohorts (p = 0.370). The 10-year overall survival was numerically superior in patients who underwent both GTR and radiotherapy: 83% compared with 67% in those who underwent GTR alone and 43% in those who underwent both STR and radiotherapy. These differences did not achieve statistical significance. Univariate analyses revealed that radiotherapy, tumor grade, and extent of resection were significant predictors of local control.
Conclusions. Gross-total resection should be the intent of surgery when it can be accomplished with an acceptable degree of morbidity. Even after GTR has been confirmed with postoperative imaging, however, adjuvant radiotherapy significantly improves local control. The authors currently recommend the use of postoperative radiotherapy, regardless of whether the resection is gross total or subtotal.
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Abstract
After an aneurysmal subarachnoid hemorrhage, nearly half of the patients die and the half who survive suffer from irreversible cerebral damage. With increasing use of noninvasive neuroimaging techniques (for example, magnetic resonance and computerized tomography angiography), more unruptured cerebral aneurysms are found. To understand the prevalence of unruptured aneurysms in the general population, along with the risks of aneurysm formation, data on growth and rupture rates are crucial. The risk of rupture in aneurysms smaller than 10 mm is still not quite clear without a population-based prospective study. Nevertheless, a 0.5 to 2% annual risk may be a reasonable estimate. Growing aneurysms and those larger than 10 mm carry a higher rate of rupture. The management of an unruptured intracranial aneurysm should be based on a thorough understanding of the natural history of these lesions and careful evaluation of the morbidity and mortality levels associated with each treatment option.
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40
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Current treatment options for unruptured intracranial aneurysms. Neurosurg Focus 2004; 17:E5. [PMID: 15633982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A patient with an unruptured intracranial aneurysm has three options: surgical clip placement, endovascular coil occlusion, and observation. The decision making about management of these lesions should be based on the risk of aneurysm rupture and the risks associated with surgical or endovascular intervention. For patients who require interventions, factors such as aneurysm recurrence rate, its location, surgical or endovascular accessibility, the patient's general medical condition, and the individual's treatment preference should be taken into account to determine the choice of therapies. Currently, a team approach by neurosurgeons and endovascular interventionists is recommended to evaluate each patient and to tailor the best treatment plan.
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Abstract
A patient with an unruptured intracranial aneurysm has three options: surgical clip placement, endovascular coil occlusion, and observation. The decision making about management of these lesions should be based on the risk of aneurysm rupture and the risks associated with surgical or endovascular intervention. For patients who require interventions, factors such as aneurysm recurrence rate, its location, surgical or endovascular accessibility, the patient's general medical condition, and the individual's treatment preference should be taken into account to determine the choice of therapies. Currently, a team approach by neurosurgeons and endovascular interventionists is recommended to evaluate each patient and to tailor the best treatment plan.
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42
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Intracranial ependymomas in the adult patient: the barrow neurological institute experience. Int J Radiat Oncol Biol Phys 2003. [DOI: 10.1016/s0360-3016(03)01283-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Is gross total resection sufficient treatment for posterior fossa ependymomas. Int J Radiat Oncol Biol Phys 2002. [DOI: 10.1016/s0360-3016(02)03410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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44
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45
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Animal model for intracerebral AVM. Clin Neurol Neurosurg 1997. [DOI: 10.1016/s0303-8467(97)81895-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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46
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Abstracts of the 6th Canadian Neuro-Oncology Meeting May 18–21, 1994 Lake Louise, Alberta. J Neurooncol 1994. [DOI: 10.1007/bf01306460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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Abstract
We performed a feasibility and safety study (phase II) of nicardipine, a calcium antagonist, in 57 patients. The objectives of the study were to begin therapy as early as possible (less than or equal to 12 hours) after the onset of ischemic stroke and to administer as high a dose as possible. All patients received an intravenous infusion of nicardipine for 72 hours, starting with a dose of 3 mg/hr and increasing to a maximum dose of 7 mg/hr. Upward titration of the dose was limited by a 10% decrease in blood pressure or a 20 beats/min increase in pulse. Intravenous therapy was followed by 30 days of oral therapy. The mean +/- SD interval from onset of stroke to commencement of therapy was 9.1 +/- 5.4 hours. Adverse reactions consisted primarily of hypotension requiring discontinuation of therapy in four patients. Score on a graded neurologic examination increased from 41/100 at baseline to 64/100 at 3 months for the 41 patients completing follow-up. There was no correlation between the dose of nicardipine administered and outcome, but the 11 patients starting therapy less than or equal to 6 hours after onset did better than those starting therapy 6-12 hours after onset. Further study of very early therapy with nicardipine is justified.
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Pilot study of nicardipine for acute ischemic stroke. Angiology 1990; 41:1017-22. [PMID: 2248424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The author performed a pilot study of nicardipine (NC), a Ca(+)+ channel blocker, to study its dosing, toxicity, and possible efficacy for hemispheric cerebral infarction within 12 hours (mean 6.9 hr) of onset to determine the advisability of proceeding with a multi-centered controlled trial. NC was administered IV (3 to 7 mg/hr) X 72 hours by titrating dose to mean arterial blood pressure (MABP not less than 10% of baseline), then orally X 30 days. Forty-three patients have been entered; mean age 63 (range 34-89), 25 male and 18 female. Only 3 had CT evidence of infarct on entry. Results have shown improvement in a 100-point (pt) graded exam (40 pts at entry, 68 pts at 3 months). Of 20 patients completing 3 months' evaluation, 17 improved and none worsened. Sixteen out of 20 were at home and 8 had minimal or no impairment. Mean Barthel's index was 72. Mean maximal serum NC level was 75 ng/mL. MABP decreased from 103 (entry) to 83 (72 hours). A larger controlled study is warranted to determine the efficacy of NC for acute cerebral infarct.
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49
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Preface. Neurosurgery 1984. [DOI: 10.1093/neurosurgery/31.cn_suppl_1.v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Preface. Neurosurgery 1983. [DOI: 10.1093/neurosurgery/30.cn_suppl_1.v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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