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Dom Mahoney, MS

Dom Mahoney, MS

Due to the tortuous path described by the vessel, PICA aneurysms present a particular challenge. In this article the authors describe the clinical features and surgical techniques used in the management of 7 complex PICA aneurysms.

 

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As is the case with many other tumours, the extent of resection of chordoma has been seen to correlate directly with prognosis. Surgical approach to these lesions is complicated due to their proximity to numerous critical neurovascular structures, however endonasal approaches are becoming more popular. Existing classification systems are based primarily on considering the requirements of open microsurgery. The authors of this article retrospectively reviewed 161 patients that underwent endonasal resection of chordomas at their unit, in order to develop a more endonasal-specific system of classification.

They describe a system of classifying endonasally approached chordomas based on their location. This system has the benefit of being more applicable to endonasal surgeries. Although the total and subtotal resection rates between tumours of the different classifications are described as ‘significant’, it is unclear whether this refers to statistical significance. The method will require further validation in larger studies before it can be fully adopted.

 

  

 

 

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(DOI: 10.1007/s10143-015-0696-1)

 

Appropriate classification of thoracolumbar spinal injuries is crucial for appropriate management of patients and communication between healthcare professionals. The thoracolumbar injury and classification score (TLICS) was designed in 2005 to stratify spinal injuries based on their morphology, neurological sequelae and the integrity of the posterior ligamentous complex. Eleven years later, authors of the above article suggest a modified approach to TLICS, which they report shows greater correlation to outcomes in their series. Both are summarised below.

 

 

 

 

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(DOI: 10.1177/0284185115580487)

 

 

 

 

Intramedullary spinal cord tumours have an estimated incidence of 1.1 cases in 100,000. Previously, the plane of dissection when surgically excising these lesions has been the key indicator for gauging extent of resection. Other articles have called into question the influence of histopathological characteristics on the definition of tumour boundary. The authors of this article report the results of a retrospective analysis determining the influence of tumour histology on resectability and neurological outcomes in cases of intramedullary spinal cord tumours. The 2016 WHO CNS classification emphasised the importance of genetic findings. This should be borne in mind when approaching results presented in articles in which this is not accounted for.

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Metastases make up the most significant group of tumours in the central nervous system in terms of incidence. Surgical resection of these lesions is often complicated by significant blood loss. Although allogenic blood product replacement is most frequently used to address this, the application of intraoperative cell salvage (IOCS) has been researched. Although the authors conclude that there is insufficient evidence to establish resolutely if IOCS is generally safe in cancer surgery, they did establish that the technique does not significantly increase the risk of tumour dissemination (a major concern in the use of IOCS). Critically, no studies on the use of IOCS in cases of spinal metastasis were included. However, the findings of the authors still provides valid justification for further investigation.

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Surgery is a heterogeneous field with varying groups of specialties involved, each associated with their own profile of patients and workload burden. With the introduction of the Global Surgery project, it is imperative to define surgical facilities that are most critical for patients to access so that efforts can be intelligently targeted and accurately assessed. The aim of this article was to propose ‘bellwether’ surgical procedures - a small number of operations which could be used to appreciate a trend in surgery as a whole. Just as a representative sample demonstrates patterns in a target population, trends regarding these bellwether procedures should exhibit patterns found across surgery.

The procedures were initially suggested by an expert panel, and then tested for their predictive capacity. This analysis determined that caesarean delivery, emergency laparotomy and open fracture fixation were all associated with highly statistically significant trends in provision of other surgical facilities.

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This review lends an insight into the use of cerebral microdialysis in patients with traumatic brain injury and subarachnoid haemorrhage. Developed in the 1970s, the technique involves the placement of a fenestrated microcatheter into the brain parenchyma - conclusions can then be drawn from analysis of the returned dialysate regarding the physiological state of the brain.

 

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Brain injury continues to present a significant treatment challenge. Not only is initial, life-saving management of these patients complicated, but progress with improving long-term neurological prognosis is slow. In such a climate, it is necessary to investigate the use of new therapies. In this article, the authors discuss the use of cerium oxide nanoparticles in models of neurological injury. The implication of free-radicals in exacerbating brain injury is demonstrated, and also the use of antioxidants to address this.

 

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Metastases are frequently reported to be the most common neoplasms in the central nervous system among adult patients. The intracranial burden of the disease is often associated with seizures - a cause of significant morbidity and mortality in itself. In this article, the authors examine the risk factors for preoperative seizures attributed to metastases, and their management postoperatively.

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Gliomatosis cerebri is a term principally used to describe a growth pattern of diffuse gliomas occupying three or more lobes. Studying this condition is complicated by its low prevalence and histological variation. The aim of this study was to elucidate the influence of clinical practice patterns on the survival of patients with gliomatosis cerebri.

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