Tuesday, September 2, 2014

Patients' cosmetic satisfaction, pain, and functional outcomes after supraorbital craniotomy through an eyebrow incision

Patients' cosmetic satisfaction, pain, and functional outcomes after supraorbital craniotomy through an eyebrow incision
Journal of Neurosurgery: Journal of Neurosurgery: Table of Contents

Journal of Neurosurgery, Volume 121, Issue 3, Page 730-734, September 2014.
Object The supraorbital approach through an eyebrow incision offers the opportunity to access a wide variety of lesions of the anterior, middle, and even the posterior fossa. The minimally invasive keyhole craniotomy limits brain exploration and retraction and offers the potential for improved surgical outcomes and reduced approach-related complications. Patient satisfaction, however, has not yet been reported in the literature. Methods From January 2002 through December 2011, the lead author (R.R.) used a supraorbital approach through an eyebrow incision for 418 patients with cerebral aneurysms, brain tumors or cystic lesions, and other miscellaneous pathological conditions. For 408 of these patients, a detailed retrospective case note review was conducted to extract data on surgical outcomes and complications, and 375 patients completed a follow-up patient satisfaction questionnaire. Results During the early perioperative period, 8 patients died (overall mortality rate 2.0%). Among patients surveyed, the overall level of satisfaction was high. Patients rated pain from the scar and headache on a scale from 1 to 5 (1 = no pain, 5 = severe pain) as follows: pain was a score of 1 for 289 patients (77.0%), 2 for 46 (12.3%), 3 for 22 (5.9%), 4 for 12 (3.2%), and 5 for 6 (1.6%). Patients also rated cosmetic outcome on a scale from 1 to 5 (1 = very pleasant, 5 = very unpleasant) as follows: outcome was a score of 1 for 315 patients (84.0%), 2 for 33 (8.8%), 3 for 14 (3.7%), 4 for 10 (2.7%), and 5 for 3 (0.8%). Postoperative chewing difficulty was reported for 8 patients (8 [2.1%] temporary, 0 permanent); palsy of the frontal muscle for 21 patients (5.6%; 13 [3.5%] temporary, 8 [2.1%] permanent); frontal hypesthesia for 31 patients (8.3%; 18 [4.8%] temporary, 13 [3.4%] permanent); and hyposmia for 11 patients (2.9%; 3 [0.8%] temporary, 8 [2.1%] permanent). Conclusions The supraorbital approach to the anterior, middle, and posterior fossae through an eyebrow incision offers a favorable rate of approach-associated surgical complications and high patient satisfaction with cosmetic outcome.

Original Article: http://thejns.org/doi/abs/10.3171/2014.4.JNS13787?ai=ru&mi=0&af=R
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Brain scans suggest people can learn to like healthy foods

Brain scans suggest people can learn to like healthy foods
Neurology News & Neuroscience News from Medical News Today

Brain scans of participants showed higher activation of reward centers shifted from high-calorie toward low-calorie food over a 6-month structured behavioral weight-loss program.

Original Article: http://www.medicalnewstoday.com/articles/281872.php
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Smoking is a negative predictor of arteriovenous malformation posttreatment obliteration: analysis of vascular risk factors in 774 patients

Smoking is a negative predictor of arteriovenous malformation posttreatment obliteration: analysis of vascular risk factors in 774 patients
Journal of Neurosurgery: Neurosurgical FOCUS: Table of Contents

Neurosurgical Focus, Volume 37, Issue 3, Page E3, September 2014.
Object Cigarette smoking has been well established as a risk factor in vascular pathology, such as cerebral aneurysms. However, tobacco's implications for patients with cerebral arteriovenous malformations (AVMs) are controversial. The object of this study was to identify predictors of AVM obliteration and risk factors for complications. Methods The authors conducted a retrospective analysis of a prospectively maintained database for all patients with AVMs treated using surgical excision, staged endovascular embolization (with N-butyl-cyanoacrylate or Onyx), stereotactic radiosurgery (Gamma Knife or Linear Accelerator), or a combination thereof between 1994 and 2010. Medical risk factors, such as smoking, abuse of alcohol or intravenous recreational drugs, hypercholesterolemia, diabetes mellitus, hypertension, and coronary artery disease, were documented. A multivariate logistic regression analysis was conducted to detect predictors of periprocedural complications, obliteration, and posttreatment hemorrhage. Results Of 774 patients treated at a single tertiary care cerebrovascular center, 35% initially presented with symptomatic hemorrhage and 57.6% achieved complete obliteration according to digital subtraction angiography (DSA) or MRI. In a multivariate analysis a negative smoking history (OR 1.9, p = 0.006) was a strong independent predictor of AVM obliteration. Of the patients with obliterated AVMs, 31.9% were smokers, whereas 45% were not (p = 0.05). Multivariate analysis of obliteration, after controlling for AVM size and location (eloquent vs noneloquent tissue), revealed that nonsmokers were more likely (0.082) to have obliterated AVMs through radiosurgery. Smoking was not predictive of treatment complications or posttreatment hemorrhage. Abuse of alcohol or intravenous recreational drugs, hypercholesterolemia, diabetes mellitus, and coronary artery disease had no discernible effect on AVM obliteration, periprocedural complications, or posttreatment hemorrhage. Conclusions Cerebral AVM patients with a history of smoking are significantly less likely than those without a smoking history to have complete AVM obliteration on follow-up DSA or MRI. Therefore, patients with AVMs should be strongly advised to quit smoking.

Original Article: http://thejns.org/doi/abs/10.3171/20145.FOCUS14121?ai=rw&mi=3ba5z2&af=R
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Natural history of brain arteriovenous malformations: a systematic review

Natural history of brain arteriovenous malformations: a systematic review
Journal of Neurosurgery: Neurosurgical FOCUS: Table of Contents

Neurosurgical Focus, Volume 37, Issue 3, Page E7, September 2014.
Object The authors aimed to systematically review the literature to clarify the natural history of brain arteriovenous malformations (BAVMs). Methods The authors searched PubMed for one or more of the following terms: natural history, brain arteriovenous malformations, cerebral arteriovenous malformations, and risk of rupture. They included studies that reported annual rates of hemorrhage and that included either 100 patients or 5 years of treatment-free follow-up. Results The incidence of BAVMs is 1.12–1.42 cases per 100,000 person-years; 38%–68% of new cases are first-ever hemorrhage. The overall annual rates of hemorrhage for patients with untreated BAVMs range from 2.10% to 4.12%. Consistently implicated in subsequent hemorrhage are initial hemorrhagic presentation, exclusively deep venous drainage, and deep and infrantentorial brain location. The risk for rupture seems to be increased by large nidus size and concurrent arterial aneurysms, although these factors have not been studied as thoroughly. Venous stenosis has not been implicated in increased risk for rupture. Conclusions For patients with BAVMs, although the overall risk for hemorrhage seems to be 2.10%–4.12% per year, calculating an accurate risk profile for decision making involves clinical attention and accounting for specific features of the malformation.

Original Article: http://thejns.org/doi/abs/10.3171/2014.6.FOCUS14250?ai=rw&mi=3ba5z2&af=R
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Treatment and outcomes of ARUBA-eligible patients with unruptured brain arteriovenous malformations at a single institution

Treatment and outcomes of ARUBA-eligible patients with unruptured brain arteriovenous malformations at a single institution
Journal of Neurosurgery: Neurosurgical FOCUS: Table of Contents

Neurosurgical Focus, Volume 37, Issue 3, Page E8, September 2014.
Object Management of unruptured arteriovenous malformations (AVMs) is controversial. In the first randomized trial of unruptured AVMs (A Randomized Trial of Unruptured Brain Arteriovenous Malformations [ARUBA]), medically managed patients had a significantly lower risk of death or stroke and had better outcomes. The University of California, San Francisco (UCSF) was one of the participating ARUBA sites. While 473 patients were screened for eligibility, only 4 patients were enrolled in ARUBA. The purpose of this study is to report the treatment and outcomes of all ARUBA-eligible patients at UCSF. Methods The authors compared the treatment and outcomes of ARUBA-eligible patients using prospectively collected data from the UCSF brain AVM registry. Similar to ARUBA, they compared the rate of stroke or death in observed and treated patients and used the modified Rankin Scale to grade outcomes. Results Of 74 patients, 61 received an intervention and 13 were observed. Most treated patients had resection with or without preoperative embolization (43 [70.5%] of 61 patients). One of the 13 observed patients died after AVM hemorrhage. Nine of the 61 treated patients had a stroke or died. There was no significant difference in the rate of stroke or death (HR 1.34, 95% CI 0.12–14.53, p = 0.81) or clinical impairment (Fisher's exact test, p > 0.99) between observed and treated patients. Conclusions The risk of stroke or death and degree of clinical impairment among treated patients was lower than reported in ARUBA. The authors found no significant difference in outcomes between observed and treated ARUBA-eligible patients at UCSF. Results in ARUBA-eligible patients managed outside that trial led to an entirely different conclusion about AVM intervention, due to the primary role of surgery, judicious surgical selection with established outcome predictors, and technical expertise developed at high-volume AVM centers.

Original Article: http://thejns.org/doi/abs/10.3171/2014.7.FOCUS14242?ai=rw&mi=3ba5z2&af=R
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