1,720,995 research outputs found
The Quest for Predictors of Shunt-Dependent Chronic Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage: Toward a Tailored Approach for Permanent Shunt-Dependency Following Aneurysmal Subarachnoid Hemorrhage
No full textMagnetic Resonance Spectrobiopsy for Prediction of Isocitrate Dehydrogenase Mutation in Glioma
No full textDespite the existence of multimodal therapy paradigm, high-grade gliomas (HGGs) remain devastating tumors associated with one of the worst prognoses. Glioblastoma (GBM) is the most frequent reported histologic type with a median survival, after surgery and combined treatment with chemotherapy and radiotherapy, ranging from 12 to 16 months. The poor prognosis is due to the lack of therapeutic efficacy of chemical agents and irradiation in hypoxic tumor areas. Experimental studies have investigated several molecules with the aim to counteract several downstream signaling important in tumor progression, unfortunately without conclusive results.
Several studies have shown that the extent of resection improves survival in patients with HGG, although the quest to achieve optimal oncologic outcomes must be tempered with the neurologic result after radical resection
Conservative Management for Odontoid Cervical Fractures: Halo or Rigid Cervical Collar?
No full textOdontoid fractures are the most common fractures of the cervical spine, especially in the elderly. They account for approximately one third of cervical spine fractures, and with the aging of the world population, the incidence and clinical and social relevance of such pathology are likely to increase. Odontoid fractures may occur from high-energy mechanisms, particularly in younger patients, but low-energy trauma may be the causative factor in the geriatric population. Overall, the treatment of patients with odontoid process fractures is based on the type of the fracture, patient's health status, age, association with neurologic deficits, and personal preference of the surgeon. Relative indications for surgery include a >5-mm fracture dislocation, a >10-degree angulation, and failed attempts at closed reduction
Concept of Spectrobiopsy Facing Gliomas: Rational and Future Perspectives Related to Target Therapy
No full textGliomas represent the most common primary intracranial tumors with an estimated incidence of 31% of all central nervous system neoplasms. Lesions originated from glial cells are extremely heterogeneous, ranging from low grade to high grade with different clinical and biological malignancy. Glioblastoma multiforme (GBM) is the most aggressive and frequent primary malignant tumor of the central nervous system in adults. Even though in the past decades considerable efforts have been made in the therapeutic management of this type of tumor,2 the prognosis after diagnosis of GBM remains extremely poor, reaching a median overall survival of 12–18 months. In 2016 the World Health Organization classified gliomas on the basis of not only phenotypic features but also genotypic ones, underlying the critical role of molecular parameters in the diagnosis, prognosis, and treatment of both low-grade and high-grade gliomas. According to the revised fourth edition of the World Health Organization classification of brain tumors, gliomas are distinguished mainly by the presence or absence of specific mutations involving the isocitrate dehydrogenase (IDH) enzymes, which result in a high concentration of the metabolite 2-hydroxyglutarate and a lack of NADPH, associated with gliomagenesis and progression of glial tumors
Cerebrospinal Fluid Dynamics Following Ventriculoperitoneal Shunt in Hydrocephalus: Do Technological Advancements Avoid Complications?
No full textIs Aspirin a Worthy Candidate in Preventing Intracranial Aneurysm Rupture?
No full textSubarachnoid hemorrhage (SAH) usually occurs with a thunderclap headache or the worst headache of a patient's life, leading to a neurologic emergency. Among cases of nontraumatic SAH, 80%–85% are caused by ruptured intracranial aneurysms (IAs) and comprise 3% of all strokes in high-income countries In the years 2000–2008, the incidence of SAH was 4–7 per 100,000 person-years in high-income and low-to middle-income countries.
Outcome after aneurysmal SAH depends on several factors, including severity of the initial hemorrhage, rebleeding, perioperative medical management, and timing and technical success for vascular malformation exclusion from the cerebral circulation. It has been estimated that 30% of patients affected by aneurysmal SAH die within 48 hours of admission, whereas up to 76% die by day 14 following hospitalization.Moreover, SAH could lead to important neurologic sequelae that decrease quality of life in nearly one third of survivors. Despite advances in diagnostic, anesthetic, and intraoperative neurosurgical techniques6 as well as preoperative and postoperative management, the ultimate overall outcome in patients with aneurysmal SAH remains unsatisfactory
Microsurgical Management of Intracranial Aneurysms After Flow Diversion Failure
No full textSubarachnoid hemorrhage (SAH) occurring after an intracranial aneurysm rupture has an incidence of 10.5 per 100,000 person-years and accounts for about 5% of strokes. The resulting outcome depends on several factors including the severity of the initial hemorrhage, rebleeding, perioperative medical management, and the timing and technical success for aneurysm treatment. The overall mortality rates from 32%−67% with 10%–20% of patients with long-term dependence due to brain damage. It is well known that 12% of patients die before achieving medical treatment and 25% die within the first 24 hours. Again, 40%–60% mortality rate occurs within 30 days. Among the surviving patients, about one third remain dependent3 and only a small minority of all SAH-affected patients has a good outcome. Despite advances in diagnostic, anesthetic, and intraoperative neurosurgical techniques, as well as preoperative and postoperative management of patients, the ultimate overall outcome in patients with aneurysmal SAH remains unsatisfactory. Many studies have explored a number of neuroprotective agents without achieving conclusive results
Minimally Invasive Surgery for Decompression in Chiari I Malformation
No full textChiari malformations (CMs) includes different pathologies sharing common anatomic deformities of the brainstem and cerebellum. CM type I was originally introduced by Hans Chiari and described as an “elongation of the tonsils and the medial parts of the inferior lobes of the cerebellum into cone-shaped projections which accompany the medulla oblongata into the spinal canal.” The prevalence of CM has been estimated to be between 0.1% and 0.5%, but it is possible that higher rates will be identified since the increasing the use of magnetic resonance imaging (MRI) in common clinical practice. Clinical studies have shown an equal prevalence in both sexes without particular ethnic or geographic distribution. Also, there are no known risk factors other than family history for such pathology. By MRI findings, Aboulezz et al.2 established that in normal conditions, the tonsils tip can extend up to 3 mm below the foramen magnum, but a displacement of the cerebellar tonsils of at least 5 mm below the foramen magnum is commonly regarded as diagnostic for CM type I
Management of Odontoid Cervical Fracture
No full textFractures of the cervical odontoid process are the most common fractures of the cervical tract, accounting for one third of all cervical spine fractures. They are more frequent in elderly patients, and with the aging of the world population, their incidence and clinical and social relevance are expected to increase in the near future. The mechanisms underlying odontoid fractures differ according to patient age, with high-energy mechanisms being the causative factor frequently encountered in younger patients and low-energy trauma commonly occurring in elderly patients. Despite rising incidence and costs, there is considerable uncertainty regarding the optimal management for these fractures, especially in elderly patients. On one hand, poor bone health and medical comorbidities in elderly patients contribute to increased surgical risk. On the other hand, nonoperative management can be associated with a risk of nonunion, resulting in complications. The balance between these options is a difficult challenge, which is completely left to the discretion of the surgeon, as validated guidelines are still missing
Maximizing the Extent of Resection in High-Grade Glioma
No full textHigh-grade gliomas (HGGs) are devastating tumors associated with one of the worst prognoses in oncology. Glioblastoma multiforme (GBM) is the most frequently reported histologic type, with a median survival after surgery and combined treatment with chemotherapy and radiotherapy of 12–16 months. Several studies have shown that the extent of resection (EOR) of the contrast-enhancing part of the tumor improves survival in patients with HGGs, although the quest to achieve optimal oncologic outcomes must be tempered with the neurologic result following radical resection. To date, limited evidence exists on the relationship between EOR and level of clinical benefit for patients with HGGs. Brown et al. reported the results of a systematic review of the literature aimed at determining whether greater EOR is associated with improved 1-year and 2-year overall survival and 6-month and 1-year progression-free survival in patients with GBM. The analysis revealed 37 studies suitable for inclusion. The authors found that gross total resection (GTR) for GBM reduces 1-year and 2-year mortality, thus supporting the use of GTR over subtotal resection and biopsy. However, it should be considered that these findings were based primarily on data from retrospective studies, which are associated with a high risk of bias. Furthermore, in the studies included in the analysis reported, EOR was almost defined arbitrary with ambiguous or unproven methodologies.12 Also, most of the studies considered have been carried out without the current technologic armamentarium
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