MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Neurosurgery Clinics of North America' source. Fri, 10 Feb 2012 03:23:40 +0100 http://www.medworm.com/index.php?rid=5438280&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001288%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438280 Wed, 23 Nov 2011 20:21:23 +0100 5438280 http://www.medworm.com/index.php?rid=5438279&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001045%2Fabstract%3Frss%3Dyes Dural arteriovenous fistulas of the cavernous sinus are no longer difficult to diagnose or treat. Specific ocular manifestations allow these fistulas to be diagnosed clinically. Noninvasive imaging techniques can be used to confirm the diagnosis. The most common treatment is endovascular occlusion of the lesion via a transarterial or transvenous route. Manual compression of the ipsilateral internal carotid artery in the neck or radiation therapy is appropriate in selected cases. Regardless of the treatment used, the fistula can be closed completely in most cases, resulting in restoration of normal orbital and intracranial blood flow and resolution of visual deficits. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438279 Wed, 23 Nov 2011 20:21:23 +0100 5438279 http://www.medworm.com/index.php?rid=5438278&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001021%2Fabstract%3Frss%3Dyes The vein of Galen aneurysmal malformation is a congenital vascular malformation that comprises 30% of the pediatric vascular and 1% of all pediatric congenital anomalies. Treatment is dependent on the timing of presentation and clinical manifestations. With the development of endovascular techniques, treatment paradigms have changed and clinical outcomes have significantly improved. In this article, the developmental embryology, clinical features and pathophysiology, diagnostic workup, and management strategies are reviewed. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438278 Wed, 23 Nov 2011 20:21:23 +0100 5438278 http://www.medworm.com/index.php?rid=5438277&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001173%2Fabstract%3Frss%3Dyes The anesthetic considerations for surgical resection of arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) incorporate many principles that are common to craniotomies for other indications. However, a high-flow, low-resistance shunt results in chronic hypoperfusion of adjacent brain tissue that is vulnerable to ischemia and at high risk for hyperemia and hemorrhage as resection of the lesion redirects blood flow. A comprehensive understanding of AVM pathophysiology and rapidly titratable anesthetic and vasoactive agents allow the anesthesiologist to alter blood pressure targets as resection evolves for optimal patient outcome. Intensive management is continued post-operatively as the brain acclimatizes to new parameters. (Source: Neurosurgery Clinics of North Ameri... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438277 Wed, 23 Nov 2011 20:21:23 +0100 5438277 http://www.medworm.com/index.php?rid=5438275&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001148%2Fabstract%3Frss%3Dyes This article discusses the considerations for selecting radiosurgery as a treatment modality in patients who present with AVMs and AVFs. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438275 Wed, 23 Nov 2011 20:21:23 +0100 5438275 http://www.medworm.com/index.php?rid=5438274&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001124%2Fabstract%3Frss%3Dyes Pial arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) are high-flow vascular lesions with abnormal communications between the arterial and venous system. AVMs are congenital lesions, whereas DAVFs are considered acquired lesions. Both can cause significant morbidity and mortality if they rupture and result in intracranial hemorrhage. The primary goal of treatment is to eliminate the risk of bleeding or at least decrease it. Because the epidemiology, clinical presentation, and classification of AVMs and DAVFs have been covered in previous articles in this issue, the authors only briefly touch on these subjects as they relate to endovascular treatment. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438274 Wed, 23 Nov 2011 20:21:23 +0100 5438274 http://www.medworm.com/index.php?rid=5438273&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001197%2Fabstract%3Frss%3Dyes This article reviews the current state of microsurgical treatment of AVMs and DAVFs. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438273 Wed, 23 Nov 2011 20:21:23 +0100 5438273 http://www.medworm.com/index.php?rid=5438272&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001161%2Fabstract%3Frss%3Dyes Arteriovenous malformations of the brain (AVMs) are a major cause of stroke in young, healthy individuals and present multiple diagnostic and therapeutic challenges, particularly in the acute setting. Although the flow hemodynamics, biology, epidemiology, and natural history of AVMs have been extensively studied, little data have been published on AVM surgery in the acute setting, and acute surgery has been claimed to possibly increase the risk of persistent neurological deficits. Although it is usually preferable to defer AVM surgery for a few weeks or months, acute surgical (open and endovascular) management is essential in specific clinical and radiological settings. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438272 Wed, 23 Nov 2011 20:21:23 +0100 5438272 http://www.medworm.com/index.php?rid=5438270&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001136%2Fabstract%3Frss%3Dyes This article provides management guidelines for arteriovenous malformations (AVMs). Management options include observation, surgical excision, endovascular embolization, and radiosurgery. Each of these can be used individually or combined for multimodal therapy based on the characteristics of the lesion. The article stratifies each lesion based on the AVM and patient characteristics to either observation or a single or multimodal treatment arm. The treatment of an AVM must be carefully weighed in each patient because of the risk of neurologic injury in functional areas of the brain and weighed against the natural history of hemorrhage. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438270 Wed, 23 Nov 2011 20:21:23 +0100 5438270 http://www.medworm.com/index.php?rid=5438269&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000994%2Fabstract%3Frss%3Dyes This article offers a review of these various classification schemes, and discusses their application to treatment decision making. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438269 Wed, 23 Nov 2011 20:21:23 +0100 5438269 http://www.medworm.com/index.php?rid=5438268&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000982%2Fabstract%3Frss%3Dyes The wide variety of arteriovenous malformation (AVM) anatomy, size, location, and clinical presentation makes patient selection for surgery a difficult process. Neurosurgeons have identified key factors that determine the risks of surgery and then devised classification schemes that integrate these factors, predict surgical results, and help select patients for surgery. These classification schemes have value because they transform complex decisions into simpler algorithms. In this review, the important grading schemes that have contributed to management of patients with brain AVMs are described, and our current approach to patient selection is outlined. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438268 Wed, 23 Nov 2011 20:21:23 +0100 5438268 http://www.medworm.com/index.php?rid=5438267&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001033%2Fabstract%3Frss%3Dyes This article discusses the role of conventional as well as advanced imaging modalities that are providing novel ways to characterize these vascular malformations. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438267 Wed, 23 Nov 2011 20:21:23 +0100 5438267 http://www.medworm.com/index.php?rid=5438266&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001185%2Fabstract%3Frss%3Dyes This article recalls the history on which current technical advances, including diagnoses, characterization, and treatment, is based. It also describes modern therapeutic options, including microsurgical, endovascular, and radiosurgery techniques. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438266 Wed, 23 Nov 2011 20:21:23 +0100 5438266 http://www.medworm.com/index.php?rid=5438264&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801100115X%2Fabstract%3Frss%3Dyes Arteriovenous malformations (AVMs) of the brain are relatively rare congenital developmental vascular lesions. They may cause hemorrhagic stroke, epilepsy, chronic headache, or focal neurologic deficits, and the incidence of asymptomatic AVMs is increasing due to widespread availability of noninvasive imaging methods. Since the most severe complication of an AVM is hemorrhagic stroke, most epidemiologic studies have concentrated on the hemorrhage risk and its risk factors. In this article, the authors discuss the epidemiology, presenting symptoms, and hemorrhage risk associated with brain AVMs. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438264 Wed, 23 Nov 2011 20:21:23 +0100 5438264 http://www.medworm.com/index.php?rid=5438263&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001203%2Fabstract%3Frss%3Dyes Brain arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) are rare and formidable lesions. The prevalence of AVMs in modern radiographic series is only about 0.2%. The prevalence of DAVFs---which are characteristically difficult to image on CT or MRI and therefore difficult to identify in screening studies---is even more challenging to ascertain, but DAVFs are probably even less common than AVMs. By contrast, intracranial aneurysms have an estimated prevalence of about 3%, which makes aneurysms 15 times more common than AVMs. The rarity of AVMs and DAVFs has frustrated any attempts to study their treatment in prospective randomized trials. Over the past century, however, neurosurgeons, neurointerventional radiologists, and radiosurgeons have made steady progress in ... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438263 Wed, 23 Nov 2011 20:21:23 +0100 5438263 http://www.medworm.com/index.php?rid=5438262&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001276%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438262 Wed, 23 Nov 2011 20:21:23 +0100 5438262 http://www.medworm.com/index.php?rid=5438261&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001264%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438261 Wed, 23 Nov 2011 20:21:23 +0100 5438261 http://www.medworm.com/index.php?rid=5438260&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001252%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438260 Wed, 23 Nov 2011 20:21:23 +0100 5438260 http://www.medworm.com/index.php?rid=5438276&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801100101X%2Fabstract%3Frss%3Dyes Arteriovenous malformations (AVMs) are vascular lesions characterized by direct connections between feeding arteries and draining veins without an intervening capillary network. Two hypotheses, normal perfusion pressure breakthrough (NPPB) and occlusive hyperemia, prevail in the literature regarding the occasional development of hemorrhage and edema following AVM resection. The NPPB hypothesis was introduced in 1978. Since the occlusive hyperemia hypothesis was first postulated in 1993, however, a debate has persisted within the cerebrovascular community concerning which hypothesis better explains the complications of edema and hemorrhage seen after AVM resection. Recent advances in cerebrovascular imaging and hemodynamic analysis have allowed a better evaluation of intracerebral changes ... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438276 Mon, 24 Oct 2011 04:00:00 +0100 5438276 http://www.medworm.com/index.php?rid=5438271&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011001008%2Fabstract%3Frss%3Dyes Cranial dural arteriovenous fistulas (DAVFs) represent an important class of cranial vascular lesions. The clinical significance of these lesions is highly dependent on the pattern of venous drainage, with cortical venous reflux being an important marker of an aggressive, high-risk fistula. For asymptomatic benign fistulas, conservative management, consisting of observation with follow-up, is a reasonable option. For symptomatic benign fistulas or aggressive fistulas, treatment is recommended. A variety of treatment modalities are available for DAVF management, including endovascular techniques, open surgery, and radiosurgery. A multimodality approach is often warranted and can offer improved chances of achieving a cure. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438271 Mon, 24 Oct 2011 04:00:00 +0100 5438271 http://www.medworm.com/index.php?rid=5438265&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000970%2Fabstract%3Frss%3Dyes Intracranial dural arteriovenous fistulas (DAVFs) are relatively rare lesions consisting of anomalous connections between dural arteries and venous sinuses and/or cortical veins. Their clinical presentation is quite variable, with symptoms dependent on their location and venous drainage pattern. Lesions with cortical venous drainage, however, have the highest risk of causing the most significant morbidity and mortality. This places an emphasis on promptly suspecting and diagnosing these lesions. This review highlights the etiology, epidemiology, clinical presentation, and clinical course of patients with intracranial DAVFs. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5438265 Mon, 24 Oct 2011 04:00:00 +0100 5438265 http://www.medworm.com/index.php?rid=5247407&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000921%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247407 Fri, 23 Sep 2011 20:50:54 +0100 5247407 http://www.medworm.com/index.php?rid=5247406&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000775%2Fabstract%3Frss%3Dyes Focal cooling may provide a safe, nondestructive alternative to resective and disconnective strategies that have been proposed or used to control refractory epilepsy. Observations of the effects of direct application of iced saline on the cortical surface during cortical mapping surgery and induced seizures have led to interest in developing implantable cooling therapy devices for refractory localizable epilepsies. In this article, the authors provide an overview of the historical background, physiology, and animal and human data leading to the development of implantable cooling devices for the treatment of medically refractory epilepsy. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247406 Fri, 23 Sep 2011 20:50:54 +0100 5247406 http://www.medworm.com/index.php?rid=5247405&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000751%2Fabstract%3Frss%3Dyes This article systematically reviews the literature regarding safety issues, potential complications, and complication avoidance strategies associated with the implantation of subdural electrodes. Knowledge of all the reported complications may help in their early detection and their prompt management. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247405 Fri, 23 Sep 2011 20:50:53 +0100 5247405 http://www.medworm.com/index.php?rid=5247404&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000714%2Fabstract%3Frss%3Dyes This article briefly reviews the fundamentals of the EEG, interictal, and ictal electrical activities of both extracranial and intracranial EEG of partial epilepsies, based on the information obtained from epilepsy patients who have undergone epilepsy surgery. The authors also present the status of their current research, focusing on decomposed seizure sources and the rendered spatial-temporal transitions in focal seizure. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247404 Fri, 23 Sep 2011 20:50:53 +0100 5247404 http://www.medworm.com/index.php?rid=5247403&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000702%2Fabstract%3Frss%3Dyes Epilepsy is characterized by intermittent, paroxysmal, hypersynchronous electrical activity that may remain localized and/or spread and severely disrupt the brain's normal multitask and multiprocessing function. Epileptic seizures are the hallmarks of such activity. The ability to issue warnings in real time of impending seizures may lead to novel diagnostic tools and treatments for epilepsy. Applications may range from a warning to the patient to avert seizure-associated injuries, to automatic timely administration of an appropriate stimulus. Seizure prediction could become an integral part of the treatment of epilepsy through neuromodulation, especially in the new generation of closed-loop seizure control systems. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247403 Fri, 23 Sep 2011 20:50:53 +0100 5247403 http://www.medworm.com/index.php?rid=5247402&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000738%2Fabstract%3Frss%3Dyes Deep brain stimulation (DBS) is an established treatment for Parkinson's disease, and is increasingly used for other neuropsychiatric conditions including epilepsy. Nevertheless, neural mechanisms for DBS and other forms of neurostimulation remain elusive. The authors measured effects of responsive neurostimulation on intracranially recorded activity from participants in a clinical investigation to assess the safety of an implantable responsive neurostimulation system in epilepsy (RNS™ System, NeuroPace, Inc.). Neurostimulation acutely suppressed gamma frequency (35–100 Hz) phase-locking. This may represent a therapeutic mechanism by which responsive neurostimulation can suppress epileptiform activity and disconnect stimulated regions from downstream targets in epilepsy and other neuro... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247402 Fri, 23 Sep 2011 20:50:53 +0100 5247402 http://www.medworm.com/index.php?rid=5247401&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000696%2Fabstract%3Frss%3Dyes Neurostimulation in epilepsy has witnessed a century-long evolution that has resulted in the use of neurostimulation to both modulate and suppress abnormal neuronal firing. The recent development of advanced responsive stimulation via a closed-loop device (the RNS System) has provided evidence that surgical epilepsy treatment continues to move toward the possibility of reducing or eliminating seizures in medically refractory patients. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247401 Fri, 23 Sep 2011 20:50:53 +0100 5247401 http://www.medworm.com/index.php?rid=5247400&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801100074X%2Fabstract%3Frss%3Dyes This article provides a critical review of the best available evidence on hippocampal stimulation for epilepsy. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247400 Fri, 23 Sep 2011 20:50:53 +0100 5247400 http://www.medworm.com/index.php?rid=5247399&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000726%2Fabstract%3Frss%3Dyes With the growing applications for deep brain stimulators (DBS) in recent years, interest in using DBS as an option for patients with epilepsy has increased. Thalamic DBS appears to be a viable minimally invasive treatment for patients experiencing medically intractable seizures. Thalamic DBS has been associated with significant reduction in seizure frequency and an improvement in overall quality of life, especially in patients who have failed maximal antiepileptic drugs or other surgical alternatives. However, further work is necessary to identify the subgroups of patients experiencing medically intractable seizures who may benefit from DBS, and also to indentify optimal stimulation parameters and mode of stimulation. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247399 Fri, 23 Sep 2011 20:50:53 +0100 5247399 http://www.medworm.com/index.php?rid=5247398&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000672%2Fabstract%3Frss%3Dyes The unique ability to stimulate bilaterally, extracranially, and non-invasively may represent a significant advantage to invasive neuromodulation therapies. In humans thus far the technique has been applied noninvasively, and is termed external trigeminal nerve stimulation (eTNSTM). (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247398 Fri, 23 Sep 2011 20:50:53 +0100 5247398 http://www.medworm.com/index.php?rid=5247397&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000684%2Fabstract%3Frss%3Dyes Medically refractory epilepsy is a morbid condition, and many patients are poor candidates for surgical resection because of multifocal seizure origin or eloquence near epileptic foci. Vagus nerve stimulation (VNS) was approved in 1997 by the US Food and Drug Administration as an adjunctive treatment of intractable epilepsy for individuals aged 12 years and more with partial epilepsy. Controversy persists regarding the efficacy of VNS for epilepsy and about which patient populations respond best to therapy. In this article, the authors retrospectively studied a patient outcome registry and report the largest, to their knowledge, analysis of VNS outcomes in epilepsy. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247397 Fri, 23 Sep 2011 20:50:53 +0100 5247397 http://www.medworm.com/index.php?rid=5247396&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000763%2Fabstract%3Frss%3Dyes This article introduces the concepts necessary for understanding these experimental studies, describing recording and stimulation technology, animal models of epilepsy, and various subcortical targets of stimulation. Bidirectional and closed-loop device technologies are also highlighted, along with the challenges presented by their experimental use. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247396 Fri, 23 Sep 2011 20:50:53 +0100 5247396 http://www.medworm.com/index.php?rid=5247395&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000842%2Fabstract%3Frss%3Dyes Epilepsy is a devastating neurological disorder that afflicts nearly 1% of the population. While resective surgery has been demonstrated to have excellent seizure-control outcomes in selected patients, many others are not candidates because the epileptogenic zone is multifocal and/or includes eloquent brain regions. Furthermore, resective surgery can be associated with neurocognitive effects, which are sometimes irreversible. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247395 Fri, 23 Sep 2011 20:50:53 +0100 5247395 http://www.medworm.com/index.php?rid=5247394&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801100091X%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247394 Fri, 23 Sep 2011 20:50:53 +0100 5247394 http://www.medworm.com/index.php?rid=5247393&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000908%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247393 Fri, 23 Sep 2011 20:50:53 +0100 5247393 http://www.medworm.com/index.php?rid=5247392&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000891%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5247392 Fri, 23 Sep 2011 20:50:53 +0100 5247392 http://www.medworm.com/index.php?rid=5077042&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000635%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077042 Thu, 30 Jun 2011 23:00:00 +0100 5077042 http://www.medworm.com/index.php?rid=5077038&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000489%2Fabstract%3Frss%3Dyes This article discusses current strategies for preoperative evaluation, operative management, and postoperative care of the pediatric patient with a newly diagnosed pineal region tumor. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077038 Thu, 30 Jun 2011 23:00:00 +0100 5077038 http://www.medworm.com/index.php?rid=5077036&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000507%2Fabstract%3Frss%3Dyes The present review assesses how to make pineal surgery, refined over decades, better, ie, less invasive, while still respecting this delicate region, and achieving anatomic and oncologic goals. An explication of anatomic principles of this region, and some basic surgical principles of keyhole surgery are provided to further assist those interested in minimizing surgical impact during pineal surgery. Although this review, for the sake of brevity, focuses on the infratentorial-supracerebellar approach, many of these principles can be adapted to other approaches, such as the occipital transtentorial, without excessive imagination. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077036 Thu, 30 Jun 2011 23:00:00 +0100 5077036 http://www.medworm.com/index.php?rid=5077035&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000520%2Fabstract%3Frss%3Dyes The pineal region can harbor highly diverse histologic tumor subtypes. Because optimal therapeutic strategies vary with tumor type, an accurate diagnosis is the foundation of enlightened management decisions. Either stereotactic biopsy or open surgery is essential for securing tissue for pathologic examination. Biopsy has the advantage of ease and minimal invasiveness but is associated with more sampling errors than open surgery. The emergence of endoscopic techniques and stereotactic radiosurgery provide complementary options to improve pineal tumor management, and will assume greater importance in the neurosurgeon's armamentarium. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077035 Thu, 30 Jun 2011 23:00:00 +0100 5077035 http://www.medworm.com/index.php?rid=5077034&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000532%2Fabstract%3Frss%3Dyes Pineal region tumors represent 0.4% to 1.0% of intracranial tumors in American literature. Obtaining a tissue diagnosis is the cornerstone of the rational management of pineal lesions. The initial surgical decision involves choosing between a stereotactic biopsy and open microsurgical procedures. Open resection facilitates the maximal removal of tumor volume and has diagnostic accuracy and improved prognosis. Stereotactic biopsy is less invasive and has a lower risk of complications. A review of all major series reporting stereotactic biopsy for pineal region lesions reveals a mean diagnostic yield of 94%, with a morbidity of 1.3% and a mortality of 8.1%. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077034 Thu, 30 Jun 2011 23:00:00 +0100 5077034 http://www.medworm.com/index.php?rid=5077032&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000544%2Fabstract%3Frss%3Dyes This article reviews and discusses the characteristic features of PCs—clinical, histological, and identifiable by various imaging modalities—which assist clinicians in narrowing the differential diagnosis for pineal lesions. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077032 Thu, 30 Jun 2011 23:00:00 +0100 5077032 http://www.medworm.com/index.php?rid=5077030&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801100043X%2Fabstract%3Frss%3Dyes The pineal gland has been studied through philosophy and science for thousands of years. Its role in human physiology was not well understood until the scientific community first started to report on pineal pathology in the eighteenth century. Throughout the nineteenth and twentieth centuries, reports on pineal tumors and the emergence of comparative anatomy allowed more complete understanding of pineal function. Neurosurgical methods of treating pineal pathology first emerged in the early twentieth century. In the latter half of the twentieth century, the emergence of microsurgical technique allowed for excellent outcomes with minimal morbidity and mortality. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077030 Thu, 30 Jun 2011 23:00:00 +0100 5077030 http://www.medworm.com/index.php?rid=5077029&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000556%2Fabstract%3Frss%3Dyes Tumors of the pineal region are a challenging clinical entity that comprises a wide range of pathology. The advent of modern neurosurgical techniques, advanced preoperative imaging, endoscopy, and neuronavigation have dramatically improved the outcomes of surgically treated patients. In this issue of Neurosurgery Clinics of North America, the authors provide us with an excellent foundation for health care providers to build on. Historical elements relevant to the evolving management of pineal region tumor patients are discussed, followed by excellent reviews addressing the pathology, preoperative workup, radiosurgical, and surgical approaches to treatment. Outcomes for some of the most common pineal region tumors are elaborated on as well. Collectively we hope this issue serves as a guide... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077029 Thu, 30 Jun 2011 23:00:00 +0100 5077029 http://www.medworm.com/index.php?rid=5077028&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000623%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077028 Thu, 30 Jun 2011 23:00:00 +0100 5077028 http://www.medworm.com/index.php?rid=5077027&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000611%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077027 Thu, 30 Jun 2011 23:00:00 +0100 5077027 http://www.medworm.com/index.php?rid=5077026&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801100060X%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077026 Thu, 30 Jun 2011 23:00:00 +0100 5077026 http://www.medworm.com/index.php?rid=5077041&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000477%2Fabstract%3Frss%3Dyes This article gives a detailed overview of the recent literature regarding the merits of stereotactic radiosurgery to pineal region tumors, and offers guidelines for the practicing neurosurgeon and neuro-oncologist for the incorporation of radiosurgery into the clinical management of these difficult lesions. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077041 Thu, 16 Jun 2011 23:00:00 +0100 5077041 http://www.medworm.com/index.php?rid=5077040&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000465%2Fabstract%3Frss%3Dyes Pineoblastomas (PBs) represent the most aggressive of the pineal parenchymal tumors. Routine treatment consists of operative management of obstructive hydrocephalus and cerebrospinal fluid studies followed by maximal resection and adjuvant chemotherapy/radiotherapy, resulting in a median survival of 20 months. Important prognostic factors for survival of patients with PB include extent of resection, age at presentation, disseminated disease, and craniospinal radiotherapy. Novel strategies being evaluated for the treatment of PB include high-dose chemotherapy with autologous stem cell therapy, stereotactic radiosurgery, and histone deacetylase inhibitors. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077040 Thu, 16 Jun 2011 23:00:00 +0100 5077040 http://www.medworm.com/index.php?rid=5077039&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000490%2Fabstract%3Frss%3Dyes Pineocytoma is a rare tumor; therefore, assimilating data from case reports and small case series to generate definitive treatment guidelines is difficult. The authors recently systematically reviewed the existing literature on outcomes for patients with pineocytoma. Gross total resection is associated with significantly increased tumor control and survival compared with subtotal resection combined with radiotherapy. When gross total resection is not possible, adding radiotherapy to subtotal resection is not associated with increases in either tumor control or survival. Although aggressive surgery in the pineal region carries the risk of neurologic injury, gross total resection should be attempted for pineocytoma. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077039 Thu, 16 Jun 2011 23:00:00 +0100 5077039 http://www.medworm.com/index.php?rid=5077031&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000519%2Fabstract%3Frss%3Dyes Tumors of the pineal region can arise from multiple cellular origins and thus represent a very heterogeneous group of pathologies. Such tumors include pineal parenchymal tumors, germ cell tumors, astrocytomas, ependymomas, and papillary pineal tumors. Within the subgroup of pineal parenchymal tumors, there is a histopathologic spectrum ranging from pineocytoma to pineal parenchymal tumors of intermediate differentiation to pineoblastoma. The current World Health Organization classification and the pathologic features of each of the pineal parenchymal tumor subtypes are reviewed in this article. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077031 Thu, 16 Jun 2011 23:00:00 +0100 5077031 http://www.medworm.com/index.php?rid=5077037&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000441%2Fabstract%3Frss%3Dyes Intracranial GCTs are a heterogeneous group of neoplasms most commonly diagnosed in the pediatric population. Germinomas are exquisitely radiosensitive with long-term survival rates in excess of 90% with radiotherapy alone. NGGCTs are associated with a poorer prognosis and are typically treated with a combination of radiation and chemotherapy. Given the young age of these patients, achieving optimal outcomes will ultimately require a careful balance of maximizing disease control while minimizing adverse treatment effects. Here we review the management of intracranial GCTs and discuss the clinical outcomes of patients who undergo treatment for these rare and fascinating tumors. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077037 Sun, 05 Jun 2011 23:00:00 +0100 5077037 http://www.medworm.com/index.php?rid=5077033&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000453%2Fabstract%3Frss%3Dyes The role of the neurosurgeon is critical for initiating preoperative evaluation and care for pineal region tumors. Preoperative evaluation of pineal region tumor can be simplified into a checklist: (1) evaluation for emergent surgical intervention due to symptomatic obstructive hydrocephalus or mass effect; (2) development of a focused differential after acquisition of craniospinal MRI, serum and cerebrospinal fluid oncoprotein levels, and cerebrospinal fluid cytology; and (3) decision on whether a biopsy, surgical resection, or both are necessary. Subsequent biopsy or surgical resection is the first step of tumor management and leads to coordination of consultation with medical and radiation oncology. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5077033 Sun, 05 Jun 2011 23:00:00 +0100 5077033 http://www.medworm.com/index.php?rid=4642119&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000143%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642119 Mon, 28 Mar 2011 18:36:38 +0100 4642119 http://www.medworm.com/index.php?rid=4642118&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000027%2Fabstract%3Frss%3Dyes This article discusses the specific requirements for establishing an fMRI program, including specific software and hardware requirements. In addition, the nature of the fMRI CPT codes is discussed. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642118 Mon, 28 Mar 2011 18:36:38 +0100 4642118 http://www.medworm.com/index.php?rid=4642117&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000040%2Fabstract%3Frss%3Dyes This article reviews neuroimaging studies of depression from the last 3 decades and describes an emerging neurocircuitry model of mood disorders, focusing on critical circuits of cognition and emotion, particularly those networks involved in the regulation of evaluative, expressive and experiential aspects of emotion. The relevance of this model for neurotherapeutics is discussed, as well as the role of functional neuroimaging of psychiatric disorders. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642117 Mon, 28 Mar 2011 18:36:38 +0100 4642117 http://www.medworm.com/index.php?rid=4642116&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010001166%2Fabstract%3Frss%3Dyes This article discusses the acquisition of intraoperative fMRI, DTI, and imaging. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642116 Mon, 28 Mar 2011 18:36:37 +0100 4642116 http://www.medworm.com/index.php?rid=4642115&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010001154%2Fabstract%3Frss%3Dyes Diffusion tensor imaging (DTI) tractography is increasingly used in presurgical mapping in tumors located in eloquent areas since it is the only non invasive technique that permits in vivo dissection of white matter tracts. Concordance between the DTI tracts and subcortical electrical intraoperative mapping is high, and DTI tractography has proven useful to guide surgery. However, it presents limitations due to the technique and the tumor, which must be known before using the images in the operative room. This review focuses on the possibilities and limits of DTI imaging in intraoperative tumoral mapping and presents an overview of current knowledge. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642115 Mon, 28 Mar 2011 18:36:37 +0100 4642115 http://www.medworm.com/index.php?rid=4642114&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000039%2Fabstract%3Frss%3Dyes This article reviews methodological aspects, clinical applications, and future directions of TMS-based mapping. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642114 Mon, 28 Mar 2011 18:36:37 +0100 4642114 http://www.medworm.com/index.php?rid=4642113&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010001191%2Fabstract%3Frss%3Dyes This article focuses on an important neurosurgical problem for which functional imaging may have a role. Temporal lobe epilepsy surgery typically involves removal of much of the anterior medial temporal lobe, which is critical for encoding and retrieval of long-term episodic memories. Verbal episodic memory decline after left anterior temporal lobe resection occurs in 30% to 60% of such patients. Recent studies show that preoperative fMRI can predict the degree of verbal memory change that will occur, and that fMRI improves prediction accuracy when combined with other routine tests. The predictive power of fMRI appears to be at least as good as the Wada memory test, making fMRI a viable noninvasive alternative to the Wada for preoperative assessment. (Source: Neurosurgery Clinics of North ... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642113 Mon, 28 Mar 2011 18:36:37 +0100 4642113 http://www.medworm.com/index.php?rid=4642112&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010001142%2Fabstract%3Frss%3Dyes Functional magnetic resonance imaging (fMRI) enhances the understanding of neuroanatomy and functions of the brain and is becoming an accepted brain-mapping tool for clinicians, researchers, and basic scientists alike. A noninvasive procedure with no known risks, fMRI has an ever-growing list of clinical applications, including presurgical mapping of motor, language, and memory functions. fMRI benefits patients and allows neurosurgeons to be aware of, and to navigate, the precise location of patient-specific eloquent cortices and structural anomalies from a tumor. Optimizing preoperative fMRI requires tailoring the fMRI paradigm to the patient's clinical situation and understanding the pitfalls of fMRI interpretation. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642112 Mon, 28 Mar 2011 18:36:37 +0100 4642112 http://www.medworm.com/index.php?rid=4642111&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801000118X%2Fabstract%3Frss%3Dyes This article presents an overview of intraoperative registration and highlights some recent developments at BWH. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642111 Mon, 28 Mar 2011 18:36:37 +0100 4642111 http://www.medworm.com/index.php?rid=4642110&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801000121X%2Fabstract%3Frss%3Dyes This article provides a basic and broad overview of DTI to enable the reader to develop an intuitive understanding of these types of data, and an awareness of their strengths and weaknesses. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642110 Mon, 28 Mar 2011 18:36:36 +0100 4642110 http://www.medworm.com/index.php?rid=4642109&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010001208%2Fabstract%3Frss%3Dyes Molecular imaging with positron emission tomography (PET) plays an important role in the diagnosis and management of patients with brain tumors and epilepsy. The clinical uses of FDG are discussed, as well as the research applications of novel PET tracers. Where applicable, single-photon emission computed tomography (SPECT) is also discussed. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642109 Mon, 28 Mar 2011 18:36:36 +0100 4642109 http://www.medworm.com/index.php?rid=4642108&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010001178%2Fabstract%3Frss%3Dyes This article reviews the history of clinical MEG, introduces the basic concepts about the biophysics of MEG, and outlines the basic neurosurgical applications of MEG. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642108 Mon, 28 Mar 2011 18:36:36 +0100 4642108 http://www.medworm.com/index.php?rid=4642107&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010001130%2Fabstract%3Frss%3Dyes This article reviews the principles underlying the mechanism of action of TMS, and discusses its use to obtain functional maps of the motor and visual cortex, including technical considerations for accuracy and reproducibility of mapping procedures. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642107 Mon, 28 Mar 2011 18:36:36 +0100 4642107 http://www.medworm.com/index.php?rid=4642106&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010001129%2Fabstract%3Frss%3Dyes This article reviews the methods, challenges, and future of fMRI. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642106 Mon, 28 Mar 2011 18:36:36 +0100 4642106 http://www.medworm.com/index.php?rid=4642105&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000052%2Fabstract%3Frss%3Dyes The development of functional mapping techniques gives neurosurgeons many options for preoperative planning. Integrating functional and anatomic data can inform patient selection and surgical planning and makes functional mapping more accessible than when only invasive studies were available. However, the applications of functional mapping to neurosurgical patients are still evolving. Functional imaging remains complex and requires an understanding of the underlying physiologic and imaging characteristics. Neurosurgeons must be accustomed to interpreting highly processed data. Successful implementation of functional image-guided procedures requires efficient interactions between neurosurgeon, neurologist, radiologist, neuropsychologist, and others, but promises to enhance the care of patie... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642105 Mon, 28 Mar 2011 18:36:35 +0100 4642105 http://www.medworm.com/index.php?rid=4642104&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000064%2Fabstract%3Frss%3Dyes The history of neurosurgical progress parallels the development of improved visualization of the brain. From early ventriculography and angiography, to the introduction of the operating microscope, the development of CT and MR imaging, and the increasing adoption of neuronavigation, neurosurgeons have dramatically improved the precision, safety, and effectiveness of brain surgery. Today neurosurgical treatment is increasingly taking advantage of rapid developments in imaging and postprocessing to decrease invasiveness and improve outcomes. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642104 Mon, 28 Mar 2011 18:36:35 +0100 4642104 http://www.medworm.com/index.php?rid=4642103&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000131%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642103 Mon, 28 Mar 2011 18:36:35 +0100 4642103 http://www.medworm.com/index.php?rid=4642102&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801100012X%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642102 Mon, 28 Mar 2011 18:36:35 +0100 4642102 http://www.medworm.com/index.php?rid=4642101&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368011000118%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4642101 Mon, 28 Mar 2011 18:36:35 +0100 4642101 http://www.medworm.com/index.php?rid=4196743&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010001075%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196743 Wed, 24 Nov 2010 16:59:59 +0100 4196743 http://www.medworm.com/index.php?rid=4196742&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000793%2Fabstract%3Frss%3Dyes The objective of this article is to present a concise summary of the most recent evidence-based guidelines in the management of metastatic brain tumors developed by the American Association of Neurologic Surgeons (AANS), Congress of Neurologic Surgeons (CNS), and the AANS/CNS Joint Section on Tumors in 2010. Target populations include patients with newly diagnosed metastases as well as recurrent or progressive lesions. The roles of radiotherapy, surgical resection, and stereotactic radiosurgery along with combination therapies are reviewed. Other topics include the role of chemotherapy, anticonvulsants, steroids, and investigational therapies. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196742 Wed, 24 Nov 2010 16:59:59 +0100 4196742 http://www.medworm.com/index.php?rid=4196741&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000768%2Fabstract%3Frss%3Dyes Contrary to the incidence of primary cancers, the incidence of brain metastasis has been increasing. This increase is likely because of the effects of an aging population, improved neuroimaging surveillance, and better control of systemic cancer, allowing time for brain metastasis to occur. Unlike systemic cancers, for which chemotherapy is the mainstay of treatment, the therapeutic strategies available to treat brain metastasis have traditionally been limited to surgical resection, whole brain radiation therapy, or stereotactic radiosurgery, either individually or in combination. It is important to put the treatment in the context of the prognosis for patients with brain metastases. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196741 Wed, 24 Nov 2010 16:59:59 +0100 4196741 http://www.medworm.com/index.php?rid=4196740&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000781%2Fabstract%3Frss%3Dyes The assessment of neurocognitive function and quality of life (QOL) in patients with brain metastases has become increasingly recognized as an important addition to traditional outcome measures such as length of survival and time to disease progression. Although objective assessment of neurocognitive function using standardized neuropsychological tests is well established, QOL represents a more subjective concept for which no gold standard assessment tool has been identified. Assessment of both neurocognitive function and QOL should involve reliable and valid measures that are sensitive to the cognitive domains and aspects of patient well-being that are most affected by brain metastases and associated treatments. Thorough evaluation of these factors is critical to understanding baseline (i... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196740 Wed, 24 Nov 2010 16:59:59 +0100 4196740 http://www.medworm.com/index.php?rid=4196739&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000744%2Fabstract%3Frss%3Dyes Leptomeningeal metastasis (LMD) is a lethal complication caused by a variety of cancers, typically developing late in the disease course. It is associated with major neurologic disabilities and short survival. The incidence of LMD may increase because of longer survival of patients who have cancer, and because of the use of newer large-molecule therapies with poor central nervous system penetration. To achieve improved outcomes for patients who have LMD, new treatments need to reach the meninges and cerebrospinal fluid and interact with relevant molecular targets. Some of the agents currently in testing may contribute to this goal. To allow for better outcomes through earlier treatment, advances in diagnosis are needed. By using agents with higher therapeutic indices, in patients with a lo... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196739 Wed, 24 Nov 2010 16:59:59 +0100 4196739 http://www.medworm.com/index.php?rid=4196738&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000732%2Fabstract%3Frss%3Dyes Skull base metastases (SBM) are rare among all tumors affecting the base of the skull. Because of their rarity, they have received limited attention in the published medical literature. Several clinical syndromes associated with SBM have been described. Knowledge of these syndromes and maintenance of a high index of suspicion are important for an early diagnosis. The majority of patients are best managed by radiotherapy. Other therapeutic options include stereotactic radiosurgery, chemotherapy, and surgery. Surgical resection is reserved for a minority of well-selected patients. The decision to intervene surgically is based on patients’ clinical status, the degree of control of systemic disease, the accessibility of the lesion, and the potential morbidity of the procedure. Well-designed ... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196738 Wed, 24 Nov 2010 16:59:59 +0100 4196738 http://www.medworm.com/index.php?rid=4196737&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000719%2Fabstract%3Frss%3Dyes In the past 20 years, surgical resection has found an established role in the management of metastatic brain tumors. Several factors, however, make strong evidence-based medicine impossible to provide for all possible patient presentations. These important factors, such as patient variables (eg, age, medical comorbidities, preoperative performance), tumor variables (eg, number, size, location, histology), and primary disease status must be taken into account on a case-by-case basis to guide patient selection and treatment strategy. Although progress has been made to answer some of the major questions in the management of metastatic brain tumors, several important questions remain. Future studies comparing surgery with stereotactic radiosurgery, for example, are needed to delineate patient ... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196737 Wed, 24 Nov 2010 16:59:59 +0100 4196737 http://www.medworm.com/index.php?rid=4196736&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000707%2Fabstract%3Frss%3Dyes Stereotactic radiosurgery (SRS) should be considered in the comprehensive treatment paradigm for all patients with brain metastases. This technique has proven benefits for local tumor control in individuals with as many as 4 lesions, and when combined with structured radiographic follow-up, will likely preserve a better quality of life for appropriately selected patients. Institutions and physicians treating patients with brain metastases should have the capability of safely performing SRS and individual cases should be prospectively reviewed by multidisciplinary teams to provide the best comprehensive care. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196736 Wed, 24 Nov 2010 16:59:59 +0100 4196736 http://www.medworm.com/index.php?rid=4196735&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000690%2Fabstract%3Frss%3Dyes Brain metastases affect 20% to 40% of patients with cancer and are the most common intracranial tumor in adults. The optimal treatment of brain metastases remains controversial. There are several patient- and treatment-related factors that must be considered to determine the optimal management for a given patient. At present, there is randomized control evidence supporting multiple treatment strategies incorporating radiotherapy. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196735 Wed, 24 Nov 2010 16:59:58 +0100 4196735 http://www.medworm.com/index.php?rid=4196734&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000720%2Fabstract%3Frss%3Dyes This article is devoted to the medical management of brain metastases, namely the role of medical treatments and chemotherapy. Radiation therapy and surgery are discussed in detail elsewhere; however, a brief discussion of all of these modalities is included for the sake of thoroughness. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196734 Wed, 24 Nov 2010 16:59:58 +0100 4196734 http://www.medworm.com/index.php?rid=4196733&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000926%2Fabstract%3Frss%3Dyes Brain metastasis is one of the most common diagnoses encountered by neurologists, neurosurgeons, radiologists, and oncologists. The aim of this article is to review imaging modalities used in the diagnosis and follow-up of brain metastases. Through the use of various imaging techniques more accurate preoperative diagnosis and more precise intraoperative planning can be made. Post-treatment evaluation can also be refined through the use of these imaging techniques. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196733 Wed, 24 Nov 2010 16:59:58 +0100 4196733 http://www.medworm.com/index.php?rid=4196732&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801000077X%2Fabstract%3Frss%3Dyes As the length of survival continues to improve for patients with systemic cancers, the problem of metastases to the chemotherapeutic sanctuary of the central nervous system (CNS) continues to grow. This review focuses on the pathobiology of brain metastasis, attempting to develop a framework for understanding the steps and molecular underpinnings of the metastatic cascade. In this process, cancer cells escape the primary tumor organ, intravasate into blood vessels, survive the hematogenous dissemination to the CNS, arrest in brain capillaries, extravasate, proliferate, and develop angiogenic abilities to succeed as an established metastasis. Each of the steps of the metastatic cascade is dependent on distinct molecular pathways, the identification of which may be exploited in attempting to... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196732 Wed, 24 Nov 2010 16:59:58 +0100 4196732 http://www.medworm.com/index.php?rid=4196731&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000756%2Fabstract%3Frss%3Dyes Metastatic tumors are the most common brain tumors in adults, and their incidence is increasing. An accurate understanding of the epidemiology of metastatic brain tumors is useful for health care professionals to allocate appropriate clinical, diagnostic, therapeutic, and research resources. Reported incidences in the literature are derived from epidemiologic population-based studies; clinical studies from surgical, radiological, and autopsy series; and reviews of hospital and clinical medical records. Despite these various sources of information, an accurate incidence of metastatic brain tumors is difficult, and current figures are estimates at best. Here, we review the available data regarding the epidemiology of metastatic brain tumors. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196731 Wed, 24 Nov 2010 16:59:58 +0100 4196731 http://www.medworm.com/index.php?rid=4196730&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000938%2Fabstract%3Frss%3Dyes There is no doubt that the incidence of metastatic cancer to the brain is increasing. As systemic cancer treatments improve, patients are living longer, but they are increasingly prone to develop brain metastases. This is primarily due to the fact that systemic treatments have limited efficacy on metastatic deposits in the brain. In the United States, there are likely to be over 250,000 new cases of brain metastases diagnosed this year. The treatment options available for patients suffering from metastases to the brain are also increasing and are often employed in combination with one another. The evidence supporting the use of these treatments is variable, which can make treatment selection somewhat difficult. This issue of Neurosurgery Clinics of North America is intended to cover the pe... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196730 Wed, 24 Nov 2010 16:59:58 +0100 4196730 http://www.medworm.com/index.php?rid=4196729&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010001063%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196729 Wed, 24 Nov 2010 16:59:58 +0100 4196729 http://www.medworm.com/index.php?rid=4196728&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010001051%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196728 Wed, 24 Nov 2010 16:59:58 +0100 4196728 http://www.medworm.com/index.php?rid=4196727&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801000104X%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4196727 Wed, 24 Nov 2010 16:59:58 +0100 4196727 http://www.medworm.com/index.php?rid=4065054&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000872%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065054 Thu, 30 Sep 2010 23:00:00 +0100 4065054 http://www.medworm.com/index.php?rid=4065053&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000628%2Fabstract%3Frss%3Dyes This article provides practical information regarding known pitfalls in intraventricular and transcranial neuroendoscopic surgeries and practical methods to reduce the incidence of these complications to the lowest rate possible. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065053 Thu, 30 Sep 2010 23:00:00 +0100 4065053 http://www.medworm.com/index.php?rid=4065052&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000689%2Fabstract%3Frss%3Dyes Movement disorders surgery, particularly deep brain stimulation (DBS), is already a minimally invasive procedure. However, new innovations in the delivery devices for DBS electrodes, new methods for target localization, and alternatives to implanted hardware are all strategies that can make movement disorders surgery less invasive. Frameless DBS techniques can increase patient comfort and shorten operative time. Interventional magnetic resonance imaging can further reduce operative time, and allows DBS placement to be done with a patient asleep and usually with a single brain penetration. Finally, gene transfer eliminates the need for implanted hardware or batteries and simplifies postoperative care. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065052 Thu, 30 Sep 2010 23:00:00 +0100 4065052 http://www.medworm.com/index.php?rid=4065051&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000677%2Fabstract%3Frss%3Dyes Intracranial vascular lesions are known to affect 2% to 4% of the population, predisposing those affected to a lifetime risk of hemorrhagic stroke, ischemia, focal neurologic deficits, or epileptic seizures. These lesions constitute a heterogeneous group, with different lesion types characterized by distinct biologic mechanisms of pathogenesis and progression. In this article, the minimally invasive management of intracranial aneurysms, arteriovenous malformations including arteriovenous fistulas, and cavernous malformations are discussed. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065051 Thu, 30 Sep 2010 23:00:00 +0100 4065051 http://www.medworm.com/index.php?rid=4065049&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000641%2Fabstract%3Frss%3Dyes This article reviews the published experience of others and introduces the authors' insights into the development of an endoscopic pituitary program. While initially challenging, this transition to endoscopic trans-sphenoidal pituitary surgery can yield rewards in the form of superior visualization and potentially more complete tumor resections. With increasing cumulative experience with the endoscopic transsphenoidal technique for pituitary surgery, the improved visualization and less steep learning curve will facilitate more widespread acceptance of endoscopic pituitary surgery as a valid alternative to the trans-septal trans-sphenoidal microscopic approach to pituitary tumors. If not a complete alternative, endoscopic-assisted pituitary surgery will also become more widespread, as endos... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065049 Thu, 30 Sep 2010 23:00:00 +0100 4065049 http://www.medworm.com/index.php?rid=4065046&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000665%2Fabstract%3Frss%3Dyes This article discusses the current state of minimally invasive endonasal techniques to address the pathologic conditions of the anterior cranial fossa and parasellar region. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065046 Thu, 30 Sep 2010 23:00:00 +0100 4065046 http://www.medworm.com/index.php?rid=4065044&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000653%2Fabstract%3Frss%3Dyes This article highlights current technologies for minimally invasive cranial neurosurgery. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065044 Thu, 30 Sep 2010 23:00:00 +0100 4065044 http://www.medworm.com/index.php?rid=4065042&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801000063X%2Fabstract%3Frss%3Dyes The present issue of Neurosurgery Clinics of North America aims to summarize the rapidly growing range of neurosurgical techniques being utilized worldwide to reduce the impact of intracranial procedures on our patients. Given our belief in the utility of the endoscope in achieving this goal in many situations, many of the articles in this issue focus on endoscopic techniques; however, it is important to point out that not all minimally invasive brain surgeries utilize the endoscope. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065042 Thu, 30 Sep 2010 23:00:00 +0100 4065042 http://www.medworm.com/index.php?rid=4065041&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000860%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065041 Thu, 30 Sep 2010 23:00:00 +0100 4065041 http://www.medworm.com/index.php?rid=4065040&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000859%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065040 Thu, 30 Sep 2010 23:00:00 +0100 4065040 http://www.medworm.com/index.php?rid=4065039&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000847%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065039 Thu, 30 Sep 2010 23:00:00 +0100 4065039 http://www.medworm.com/index.php?rid=4065050&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000616%2Fabstract%3Frss%3Dyes This article focuses on minimally invasive approaches used to address disorders of cerebrospinal fluid (CSF) circulation. The author covers the primary CSF disorders that are amenable to minimally invasive treatment, including aqueductal stenosis, fourth ventricular outlet obstruction (including Chiari malformation), isolated lateral ventricle, isolated fourth ventricle, multiloculated hydrocephalus, arachnoid cysts, and tumors that block CSF flow. General approaches to evaluating disorders of CSF circulation, including detailed imaging studies, are discussed. Approaches to minimally invasive management of such disorders are described in general, and for each specific entity. For each procedure, indications, surgical technique, and known outcomes are detailed. Specific complications as wel... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065050 Thu, 09 Sep 2010 23:00:00 +0100 4065050 http://www.medworm.com/index.php?rid=4065045&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000586%2Fabstract%3Frss%3Dyes This article considers common minimally invasive craniotomy approaches and the role of neuroendoscopy in the removal of extra-axial and intra-axial brain tumors, excluding those of the ventricle. The use of a keyhole craniotomy combined with a carefully selected trajectory can help avoid the disadvantages associated with a standard craniotomy. However, the decision to use endoscopy must be individualized based on the patient and tumor. Endoscopy can also be used as a surgical adjunct to improve tumor resection and to help protect neurovascular structures. Complications associated with minimally invasive tumor neurosurgery have been similar to those associated with conventional neurosurgical approaches, and available outcomes are promising. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065045 Sun, 29 Aug 2010 23:00:00 +0100 4065045 http://www.medworm.com/index.php?rid=4065047&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000598%2Fabstract%3Frss%3Dyes Skull base lesions that involve the middle and posterior cerebral fossae have been historically managed through extensive transcranial approaches. The development of endoscopic endonasal techniques during the past decade has made possible a vast array of alternative routes to the ventral skull base, providing the ability to expose lesions in difficult-to-access regions of the cranial base in a less invasive manner. In this review, the authors detail the endoscopic surgical anatomy and the operative nuances of the expanded endoscopic endonasal approaches to tumors of the middle and posterior cranial fossae. These techniques offer excellent exposure of the targeted regions yielding optimal resections, while avoiding the morbidity associated with transcranial surgical approaches. (Source: Neu... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065047 Thu, 26 Aug 2010 23:00:00 +0100 4065047 http://www.medworm.com/index.php?rid=4065043&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000574%2Fabstract%3Frss%3Dyes Applying the concept of keyhole techniques to neurosurgery has divided the neurosurgical community. This should never have happened because keyhole refers to a philosophy not a size. This philosophy stems from a desire to minimize collateral damage without compromising the intended goal of surgery. The revolution received its impetus from technological advances in pre- and intraoperative navigation, use of surgical-friendly anesthetic agents, lower profile instruments, the introduction of hemostatic agents, and better visualization. If a smaller craniotomy compromises the goal of surgery, then the approach should be re-evaluated and modified to achieve minimal collateral damage and maximal efficacy. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065043 Thu, 26 Aug 2010 23:00:00 +0100 4065043 http://www.medworm.com/index.php?rid=4065048&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000604%2Fabstract%3Frss%3Dyes Endonasal, endoscopic approaches to the cranial base have undergone significant technique refinement over the past decade. Repair of the resultant defects remains perhaps the most important concern with these approaches; however, recent advances suggest that with careful attention to the closure, these procedures can be done with acceptable rates of morbidity. In this review, the authors discuss known techniques for the repair of endonasal defects, and provide some insight based on their experience. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4065048 Sun, 08 Aug 2010 23:00:00 +0100 4065048 http://www.medworm.com/index.php?rid=3671387&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000471%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671387 Fri, 18 Jun 2010 07:54:23 +0100 3671387 http://www.medworm.com/index.php?rid=3671386&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000379%2Fabstract%3Frss%3Dyes Moyamoya is an increasingly recognized cause of stroke in children and adults. Identification of the disease early in its course with prompt institution of therapy is critical to providing the best outcome for patients. Revascularization surgery seems to be effective in preventing stroke in moyamoya, with direct techniques providing durable protection when performed at experienced centers. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671386 Fri, 18 Jun 2010 07:54:23 +0100 3671386 http://www.medworm.com/index.php?rid=3671385&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000306%2Fabstract%3Frss%3Dyes There have been many indirect revascularization techniques described by surgeons for the treatment of moyamoya disease. These surgical procedures are typically used more commonly in pediatric, than in adults', cases. Some of the techniques include: cervical sympathectomy, omental transplantation, multiple burr holes, encephalo-myo-synangiosis (EMS), encephalo-arterio-synangiosis (EAS), encephalo-duro-synangiosis (EDS), encephalo-myo-arterio-synangiosis (EMAS), encephalo-duro-arterio-synangiosis (EDAS), encephalo-duro-arterio-myo-synangiosis (EDAMS), encephalo-duro-galeo (periosteal)-synangiosis (EDGS), and combinations of all the above. This chapter will detail the technical aspects of many of these procedures and some of the reported clinical outcomes. (Source: Neurosurgery Clinics of Nor... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671385 Fri, 18 Jun 2010 07:54:23 +0100 3671385 http://www.medworm.com/index.php?rid=3671384&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801000029X%2Fabstract%3Frss%3Dyes This article discusses the epidemiology, presentation, and diagnosis of this condition in children. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671384 Fri, 18 Jun 2010 07:54:23 +0100 3671384 http://www.medworm.com/index.php?rid=3671383&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000318%2Fabstract%3Frss%3Dyes This report reviews the available literature regarding the current trends in diagnosis and management of pediatric traumatic vascular injuries. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671383 Fri, 18 Jun 2010 07:54:22 +0100 3671383 http://www.medworm.com/index.php?rid=3671382&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000288%2Fabstract%3Frss%3Dyes This article reviews the literature pertaining to pediatric venous sinus thrombosis. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671382 Fri, 18 Jun 2010 07:54:22 +0100 3671382 http://www.medworm.com/index.php?rid=3671381&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000264%2Fabstract%3Frss%3Dyes This article explores the presentation, natural history, investigation, and treatment of spinal AVMs, spinal AVFs, and spinal cavernous malformations. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671381 Fri, 18 Jun 2010 07:54:22 +0100 3671381 http://www.medworm.com/index.php?rid=3671380&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000276%2Fabstract%3Frss%3Dyes Intracranial pediatric aneurysms arising in children are rare. The treatment of these lesions requires both an understanding of their unique features as well as surgical, interventional, and pediatric critical care expertise offered through a multidisciplinary setting. The patient population, clinical presentation, complications, and trends in treatments are discussed in this article. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671380 Fri, 18 Jun 2010 07:54:22 +0100 3671380 http://www.medworm.com/index.php?rid=3671379&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000252%2Fabstract%3Frss%3Dyes This article discusses the epidemiology, natural history, diagnosis, treatment and follow-up of children who are found to harbor these lesions. CMs affect children by causing hemorrhage, seizure, focal neurologic deficits, and headache. Diagnosis is best made with magnetic resonance imaging. Patients with multiple lesions should be referred for genetic evaluation and counseling. Individuals with symptomatic, growing, or hemorrhagic malformations should be considered for surgical resection. Close follow-up after diagnosis and treatment is helpful to identify lesion progression or recurrence. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671379 Fri, 18 Jun 2010 07:54:22 +0100 3671379 http://www.medworm.com/index.php?rid=3671378&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801000032X%2Fabstract%3Frss%3Dyes Pediatric vascular malformations of the central nervous system differ from those seen in adults. Their classification may be based on symptoms, pathomechanics, patient's age, morphologic features, or presumed etiology. This review describes the different classification schemes and the endovascular management options of these rare and challenging diseases. The proposed etiologic classification of pediatric vascular malformations may add to our understanding of these diseases in general because the phenotypic expression of a given vascular malformation can shed light on the nature and timing of the causative agent, thereby potentially opening up treatment modalities in the future that are directed against the triggering event rather than against the clinical manifestations or the morphologic... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671378 Fri, 18 Jun 2010 07:54:22 +0100 3671378 http://www.medworm.com/index.php?rid=3671377&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000240%2Fabstract%3Frss%3Dyes Children with intracranial arteriovenous malformations (AVM) have a high cumulative risk of hemorrhage and therefore effective treatment of AVMs in the pediatric population is imperative. Treatment options include microsurgical resection, endovascular embolization, staged or single fraction radiosurgery, or some combination of these treatments, with the ultimate goal of eliminating the risk of hemorrhage. In this article the authors review the current data on the use of radiosurgery for the treatment of childhood AVMs. Factors associated with successful AVM radiosurgery in this population are examined, and comparisons with outcomes in adult patients are reviewed. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671377 Fri, 18 Jun 2010 07:54:22 +0100 3671377 http://www.medworm.com/index.php?rid=3671376&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000343%2Fabstract%3Frss%3Dyes Arteriovenous malformation (AVM) is the most common cause of spontaneous intraparenchymal hemorrhage in children, excluding hemorrhages of prematurity and early infancy. Because most children diagnosed with an AVM undergo initial treatment emergently, the natural history of AVMs in the pediatric population is not well understood. Most pediatric AVMs do not come to clinical attention unless they hemorrhage. Therefore, their optimal management remains controversial. Children with intracranial AVMs represent a special challenge in that they harbor unacceptable lifelong risks of hemorrhage and potential neurologic deficits. Patients should be evaluated on a case-by-case basis to determine the best multidisciplinary treatment regimen that can be used to preserve neurologic function and eradicat... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671376 Fri, 18 Jun 2010 07:54:22 +0100 3671376 http://www.medworm.com/index.php?rid=3671375&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000239%2Fabstract%3Frss%3Dyes Pediatric and inherited neurovascular syndromes have diverse presentations and treatments. Although many of these diseases are uncommon, they must be included in the differential diagnosis for children with strokes or hemorrhages. In neurosurgical practice, familial cavernous malformations, hereditary hemorrhagic telangiectasia (HHT), and moyamoya are the most frequently encountered of these diseases. In this article, we will discuss familial cavernomas and HHT, as well as more unusual entities such as PHACE(S) syndrome, Klippel-Trenaunay syndrome, Wyburn-Mason syndrome, sinus pericranii, radiation-induced vasculopathy, and blue rubber bleb nevus (BRBN) syndrome. Moyamoya disease is covered in several other articles in this volume. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671375 Fri, 18 Jun 2010 07:54:22 +0100 3671375 http://www.medworm.com/index.php?rid=3671374&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000331%2Fabstract%3Frss%3Dyes The brain vascular system develops in such a way that it continuously adapts the supply of oxygen and other nutrients to the needs of the parenchyma. To accompany the developing brain vesicles, it evolves in several steps: superficial meningeal network first; intraventricular choroid plexuses which determine the arterial pattern; penetrating capillaries from the surface to the ventricular germinal matrix forming simple transcerebral arteriovenous loops; cortical capillaries last, mainly in the last trimester. The venous return becomes connected to both the surface and to the choroidal veins, so forming distinct meningeal and subependymal venous drainage systems, while the arteries are on the surface only. While the arterial system was determined early (week 8), the venous system is continu... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671374 Fri, 18 Jun 2010 07:54:22 +0100 3671374 http://www.medworm.com/index.php?rid=3671373&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000380%2Fabstract%3Frss%3Dyes Children afflicted with neurovascular diseases can pose formidable diagnostic and therapeutic challenges to neurosurgeons. Recent technologic advancements in neuroimaging, endovascular therapies, radiosurgery, and intraoperative capabilities have provided new tools to help overcome many of these challenges. Increasingly, the use of multidisciplinary teams in the management of these conditions has markedly improved the ability of clinicians to achieve optimal outcomes. As guest editors of this issue of Neurosurgery Clinics of North America, we are proud to have assembled a series of articles on these topics from a distinguished group of specialists in this field. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671373 Fri, 18 Jun 2010 07:54:22 +0100 3671373 http://www.medworm.com/index.php?rid=3671372&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236801000046X%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671372 Fri, 18 Jun 2010 07:54:22 +0100 3671372 http://www.medworm.com/index.php?rid=3671371&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000458%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671371 Fri, 18 Jun 2010 07:54:22 +0100 3671371 http://www.medworm.com/index.php?rid=3671370&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000446%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3671370 Fri, 18 Jun 2010 07:54:22 +0100 3671370 http://www.medworm.com/index.php?rid=3448562&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000094%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448562 Wed, 31 Mar 2010 23:00:00 +0100 3448562 http://www.medworm.com/index.php?rid=3448561&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001181%2Fabstract%3Frss%3Dyes Subarachnoid hemorrhage from the rupture of a saccular aneurysm is a devastating neurological disease that has a high morbidity and mortality not only from the initial hemorrhage, but also from the delayed complications, such as cerebral vasospasm. Cerebral vasospasm can lead to delayed ischemic injury 1 to 2 weeks after the initial hemorrhage. Although the pathophysiology of vasospasm has been described for decades, the molecular basis remains poorly understood. With the many advances in the past decade in the development of sensitive molecular biological techniques, imaging, biochemical purification, and protein identification, new insights are beginning to reveal the etiology of vasospasm. These findings will not only help to identify markers of vasospasm and prognostic outcome, but wil... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448561 Wed, 31 Mar 2010 23:00:00 +0100 3448561 http://www.medworm.com/index.php?rid=3448560&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236800900117X%2Fabstract%3Frss%3Dyes Morbidity and mortality of patients with aneurysmal subarachnoid hemorrhage (aSAH) is significantly related to the development of chronic cerebral vasospasm. Despite extensive clinical and experimental research, the pathophysiology of the events that result in delayed arterial spasm is not fully understood. A review of the published literature on cerebral vasospasm that included but was not limited to all PubMed citations from 1951 to the present was performed. The findings suggest that leukocyte-endothelial cell interactions play a significant role in the pathophysiology of cerebral vasospasm and explain the clinical variability and time course of the disease. Experimental therapeutic targeting of the inflammatory response when timed correctly can prevent vasospasm, and supplementation of... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448560 Wed, 31 Mar 2010 23:00:00 +0100 3448560 http://www.medworm.com/index.php?rid=3448559&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001156%2Fabstract%3Frss%3Dyes This article reviews the risk factors for vasospasm; the various methods for diagnosing vasospasm including the conventional 4-vessel angiography, computed tomographic angiography, and computed tomographic perfusion; the methods to detect vasospasm before clinical onset (including transcranial Doppler ultrasonography); and the recent emergence of multimodality monitoring. A discussion of medical treatment options in the setting of vasospasm is also included; the prophylactic use of “neuroprotectants” such as nimodipine, statins, and magnesium and the role of hemodynamic augmentation in vasospasm amelioration, including the use of inotropic support in addition to traditional triple-H therapy, are discussed. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448559 Wed, 31 Mar 2010 23:00:00 +0100 3448559 http://www.medworm.com/index.php?rid=3448558&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236800900120X%2Fabstract%3Frss%3Dyes Cerebral salt wasting (CSW) is a syndrome of hypovolemic hyponatremia caused by natriuresis and diuresis. The mechanisms underlying CSW have not been precisely delineated, although existing evidence strongly implicates abnormal elevations in circulating natriuretic peptides. The key in diagnosis of CSW lies in distinguishing it from the more common syndrome of inappropriate secretion of antidiuretic hormone. Volume status, but not serum and urine electrolytes and osmolality, is crucial for making this distinction. Volume and sodium repletion are the goals of treatment of patients with CSW, and this can be performed using some combination of isotonic saline, hypertonic saline, and mineralocorticoids. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448558 Wed, 31 Mar 2010 23:00:00 +0100 3448558 http://www.medworm.com/index.php?rid=3448557&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001211%2Fabstract%3Frss%3Dyes The prevention and management of medical complications are important for improving outcomes after subarachnoid hemorrhage (SAH). Fever, anemia requiring transfusion, hyperglycemia, hyponatremia, pneumonia, hypertension, and neurogenic cardiopulmonary dysfunction occur frequently after SAH. There is increasing evidence that acute hypoxia and extremes of blood pressure can exacerbate brain injury during the acute phase of bleeding. There are promising strategies to minimize these complications. Randomized controlled trials are needed to evaluate the risks and benefits of these and other medical management strategies after SAH. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448557 Wed, 31 Mar 2010 23:00:00 +0100 3448557 http://www.medworm.com/index.php?rid=3448556&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001144%2Fabstract%3Frss%3Dyes Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating condition, requiring prompt diagnosis and therapeutic intervention as well as close monitoring for the development of complications including vasospasm (VS). Although digital subtraction angiography is still considered the gold standard for the diagnosis of aSAH (and vasospasm), new and less invasive modalities are emerging including ultrasound, CT, CT angiography and CT perfusion, and MR imaging. The current evidence for the use of these newer modalities is described for the diagnosis of aSAH and the management of its sequelae including VS. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448556 Wed, 31 Mar 2010 23:00:00 +0100 3448556 http://www.medworm.com/index.php?rid=3448555&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001193%2Fabstract%3Frss%3Dyes Transcranial Doppler ultrasonography (TCD) is a tool employed by the neurosurgeon and neurointensivist in the management of vasospasm in the intensive care unit after aneurysmal subarachnoid hemorrhage. A review of the current indications, monitoring parameters, indices, and relevance of modern TCD technology is provided, as well as algorithms for the use of TCD ultrasonography in the management of patients with subarachnoid hemorrhage. Other current uses of TCD ultrasonography are also discussed in the setting of neurocritical care. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448555 Wed, 31 Mar 2010 23:00:00 +0100 3448555 http://www.medworm.com/index.php?rid=3448554&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001168%2Fabstract%3Frss%3Dyes This article discusses the use of these endovascular techniques in the management of vasospasm and provides a current review of literature. Sustained efficacy of intra-arterial vasodilators is less well established at this time, and repeated treatments may be necessary. Balloon angioplasty is an effective technique in treating vasospasm and results in durable clinical improvement. It should be used judiciously, however, given a small risk of vessel rupture associated with intracranial angioplasty. The goal of angioplasty should be improvement of vessel caliber to augment flow rather than to achieve a picture-perfect result. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448554 Wed, 31 Mar 2010 23:00:00 +0100 3448554 http://www.medworm.com/index.php?rid=3448553&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001120%2Fabstract%3Frss%3Dyes Aneurysmal subarachnoid hemorrhage is a deadly disease associated with high morbidity and mortality. Surgical clipping has been the gold standard treatment for more than 70 years. Endovascular therapy is now accepted as a valid alternative therapeutic modality. The authors' approach emphasizes collaboration between endovascular and surgical specialists. The array of new endovascular techniques has extended beyond the Guglielmi Detachable Coil to include new stents and flow-diverting devices. The future promises expansion of the number of types of aneurysms that are treatable with endovascular techniques. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448553 Wed, 31 Mar 2010 23:00:00 +0100 3448553 http://www.medworm.com/index.php?rid=3448552&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001223%2Fabstract%3Frss%3Dyes Hydrocephalus is a common and potentially devastating complication of aneurysmal subarachnoid hemorrhage (SAH). Its incidence is approximately 20% to 30%, and its onset can be acute, within 48 hours after SAH, or rarely chronic, occurring in a delayed fashion weeks and even months after the hemorrhage. Early recognition of its signs and symptoms and accurate interpretation of computed tomography (CT) studies are important for the management of patients with SAH. Clinically, a poor neurologic grade has the highest correlation with an increased incidence of hydrocephalus. Radiographically, the bicaudate index on CT studies has emerged as the best marker of this condition. Although further studies are needed to understand the complex pathophysiology of this condition, hydrocephalus after SAH ... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448552 Wed, 31 Mar 2010 23:00:00 +0100 3448552 http://www.medworm.com/index.php?rid=3448551&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001119%2Fabstract%3Frss%3Dyes This report focuses on the modern surgical management of patients with aSAH. Following a brief historical perspective on the origin of aneurysm surgery, the topics discussed include the timing of surgical intervention after aSAH, commonly used surgical approaches and craniotomies, fenestration of the lamina terminalis, intraoperative neurophysiological monitoring, intraoperative digital subtraction and fluorescent angiography, temporary clipping, deep hypothermic cardiopulmonary bypass, management of acute hydrocephalus, cerebral revascularization, and novel clip configurations and microsurgical techniques. Many of the topics highlighted in this report represent some of the more debated techniques in vascular neurosurgery. The popularity of such techniques is constantly evolving as new stu... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448551 Wed, 31 Mar 2010 23:00:00 +0100 3448551 http://www.medworm.com/index.php?rid=3448550&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001235%2Fabstract%3Frss%3Dyes Aneurysmal subarachnoid hemorrhage (aSAH) is a neurosurgical catastrophe. It affects 33,000 patients in the United States annually and has a mortality rate of 50% to 60% at 30 days. Half of the survivors are dependent. Outcome is closely related to the level of consciousness at the time of presentation, global cerebral edema, subarachnoid blood load as seen on CT, and rehemorrhage. Age, hyperglycemia, and medical complications are associated with worse outcomes. The cost impact factor of this condition is high from a financial perspective as well as from a patient perspective. Care givers show increased morbidity when compared with the nonaffected community. Early aggressive treatment of good grade patients seems to provide the best outcome for this serious condition. (Source: Neurosurgery... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448550 Wed, 31 Mar 2010 23:00:00 +0100 3448550 http://www.medworm.com/index.php?rid=3448549&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001107%2Fabstract%3Frss%3Dyes Aneurysmal subarachnoid hemorrhage (aSAH) is a form of hemorrhagic stroke that affects up to 30,000 individuals per year in the United States. The incidence of aSAH has been shown to be associated with numerous nonmodifiable (age, gender, ethnicity, family history, aneurysm location, size) and modifiable (hypertension, body mass index, tobacco and illicit drug use) risk factors. Although early repair of ruptured aneurysms and aggressive postoperative management has improved overall outcomes, it remains a devastating disease, with mortality approaching 50% and less than 60% of survivors returning to functional independence. As treatment modalities change and the percentage of minority and elderly populations increase, it is critical to maintain an up-to-date understanding of the epidemiolog... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448549 Wed, 31 Mar 2010 23:00:00 +0100 3448549 http://www.medworm.com/index.php?rid=3448548&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001090%2Fabstract%3Frss%3Dyes The incidence of aneurysmal subarachnoid hemorrhage (aSAH) is between 6 and 8 cases per 100,000 persons per annum in the West. It affects some 20,000 to 30,000 Americans each year. In recent decades, the treatment of vasospasm has advanced. Several new clinical trials involving the surgical and endovascular as well as medical management of aSAH have changed the intellectual foundation of the treatment of this disorder. The development of new endovascular techniques has expanded the breadth and effectiveness of the surgical options available to neurosurgeons in caring for these patients. Understanding of the underlying molecular biology of this disorder has given insight into genetic risk factors predisposing to hemorrhage and vasospasm. Inflammation's role in the development of vasospasm i... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448548 Wed, 31 Mar 2010 23:00:00 +0100 3448548 http://www.medworm.com/index.php?rid=3448547&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000082%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448547 Wed, 31 Mar 2010 23:00:00 +0100 3448547 http://www.medworm.com/index.php?rid=3448546&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000070%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448546 Wed, 31 Mar 2010 23:00:00 +0100 3448546 http://www.medworm.com/index.php?rid=3448545&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368010000069%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3448545 Wed, 31 Mar 2010 23:00:00 +0100 3448545 http://www.medworm.com/index.php?rid=3039547&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009001314%2Fabstract%3Frss%3Dyes (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3039547 Mon, 30 Nov 2009 16:46:14 +0100 3039547 http://www.medworm.com/index.php?rid=3039546&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009000722%2Fabstract%3Frss%3Dyes This article provides an overview of the interactions between the central nervous system and the immune system, and discusses the challenges facing current immunotherapeutic strategies. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3039546 Mon, 30 Nov 2009 16:46:14 +0100 3039546 http://www.medworm.com/index.php?rid=3039545&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009000874%2Fabstract%3Frss%3Dyes This article reviews methods of monitoring the immune system after vaccination against malignant gliomas. Improvements in immunomonitoring should lead to an increase in the efficiency of identifying viable avenues of therapeutic research, and assess the efficacy of those currently employed. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3039545 Mon, 30 Nov 2009 16:46:14 +0100 3039545 http://www.medworm.com/index.php?rid=3039544&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009000862%2Fabstract%3Frss%3Dyes This article provides a broad overview of the data, including laboratory and clinical studies, currently available on the combination of immunotherapy and chemotherapy for treating cancer. The various forms of immunotherapy combined with chemotherapy include monoclonal antibodies, adoptive lymphocyte transfer, or active specific immunotherapy, such as tumor proteins, irradiated tumor cells, tumor cell lysates, dendritic cells pulsed with peptides or lysates, or tumor antigens expressed in plasmids or viral vectors. This discussion is not limited to malignant brain tumors, because many of the studies have been conducted on various cancer types, thereby providing a comprehensive perspective that may encourage further studies that combine chemotherapy and immunotherapy for treating brain tumo... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3039544 Mon, 30 Nov 2009 16:46:14 +0100 3039544 http://www.medworm.com/index.php?rid=3039543&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009000734%2Fabstract%3Frss%3Dyes Recent advancements have made radiation and chemotherapy the standard of care for newly diagnosed glioblastomas. The use of these therapies has resulted in an increased diagnosis of pseudoprogression and radiation-induced necrosis. Standard MRI techniques are inadequate in differentiating tumor recurrence from posttreatment effects. Diagnosis of a posttreatment lesion as glioma recurrence rather than radiochemotherapy or immunotherapy treatment effect is critical. This increase in accuracy plays a role as newer immunotherapies incurring posttreatment effects on MRI emerge. Advancements with magnetic resonance spectroscopy, diffusion-weighted imaging, and functional positron emission tomography scans have shown promising capabilities. Further investigations are necessary to assess the imagi... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3039543 Mon, 30 Nov 2009 16:46:14 +0100 3039543 http://www.medworm.com/index.php?rid=3039542&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009000837%2Fabstract%3Frss%3Dyes This article reviews the intersection between the use of viral therapy and immunotherapy in the treatment of malignant gliomas. Each approach shows great promise on its own and in combined or integrated forms. (Source: Neurosurgery Clinics of North America) Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3039542 Mon, 30 Nov 2009 16:46:14 +0100 3039542 http://www.medworm.com/index.php?rid=3039541&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS104236800900076X%2Fabstract%3Frss%3Dyes Glioma, especially high-grade glioblastoma multiforme (GBM), is the most common and aggressive type of brain tumor, accounting for about half of all the primary brain tumors. Despite continued advances in surgery, chemotherapy, and radiotherapy, the clinical outcomes remain dismal. The 2-year survival rate of GBM is less than 30%. Better understanding of GBM biology is needed to develop novel therapies. Recent studies have demonstrated the existence of a small subpopulation of cells with stemlike features called cancer stem cells (CSCs). These GBM CSCs are self renewable and highly tumorigenic. They not only are chemo-radio resistant but also often contain multidrug resistance genes and drug transporter genes. These characteristics enable GBM CSCs to survive standard cytotoxic therapies. A... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3039541 Mon, 30 Nov 2009 16:46:14 +0100 3039541 http://www.medworm.com/index.php?rid=3039540&cid=s_33238_153_f&fid=33238&url=http%3A%2F%2Fwww.neurosurgery.theclinics.com%2Farticle%2FPIIS1042368009000886%2Fabstract%3Frss%3Dyes Over the past decade, dendritic cell–based immunotherapy for central nervous system tumors has progressed from preclinical rodent models and safety assessments to phase I/II clinical trials in over 200 patients, which have produced measurable immunologic responses and some prolonged survival rates. Many questions regarding the methods and molecular mechanisms behind this new treatment option, however, remain unanswered. Results from currently ongoing and future studies will help to elucidate which dendritic cell preparations, treatment protocols, and adjuvant therapeutic regimens will optimize the efficacy of dendritic cell vaccination. As clinical studies continue to report results on dendritic cell–mediated immunotherapy, it will be critical to continue refining treatment methods and... Neurosurgery Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3039540 Mon, 30 Nov 2009 16:46:13 +0100 3039540