Abstract:
OBJECT:The aim of this study was to determine age-related differences in short-term (1-year) outcomes in patients with unruptured intracranial aneurysms (UIAs). METHODS:Four thousand fifty-nine patients prospectively enrolled in the International Study of Unruptured Intracranial Aneurysms were categorized into 3 groups by age at enrollment: < 50, 50-65, and > 65 years old. Outcomes assessed at 1 year included aneurysm rupture rates, combined morbidity and mortality from aneurysm procedure or hemorrhage, and all-cause mortality. Periprocedural morbidity, in-hospital morbidity, and poor neurological outcome on discharge (Rankin scale score of 3 or greater) were assessed in surgically and endovascularly treated groups. Univariate and multivariate associations of each outcome with age were tested. RESULTS:The risk of aneurysmal hemorrhage did not increase significantly with age. Procedural and in-hospital morbidity and mortality increased with age in patients treated with surgery, but remained relatively constant with increasing age with endovascular treatment. Poor neurological outcome from aneurysm- or procedure-related morbidity and mortality did not differ between management groups for patients 65 years old and younger, but was significantly higher in the surgical group for patients older than 65 years: 19.0% (95% confidence interval [CI] 13.9%-24.4%), compared with 8.0% (95% CI 2.3%-13.6%) in the endovascular group and 4.2% (95% CI 2.3%-6.2%) in the observation group. All-cause mortality increased steadily with increasing age, but differed between treatment groups only in patients < 50 years of age, with the surgical group showing a survival advantage at 1 year. CONCLUSIONS:Surgical treatment of UIAs appears to be safe, prevents 1-year hemorrhage, and may confer a survival benefit in patients < 50 years of age. However, surgery poses a significant risk of morbidity and death in patients > 65 years of age. Risk of endovascular treatment does not appear to increase with age. Risks and benefits of treatment in older patients should be carefully considered, and if treatment is deemed necessary for patients older than 65 years, endovascular treatment may be the best option.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Mahaney KB,Brown RD Jr,Meissner I,Piepgras DG,Huston J 3rd,Zhang J,Torner JC,ISUIA Investigators.doi
10.3171/2014.6.JNS121179subject
Has Abstractpub_date
2014-11-01 00:00:00pages
1024-38issue
5eissn
0022-3085issn
1933-0693journal_volume
121pub_type
杂志文章,多中心研究abstract:OBJECT:The application accuracy of the Neuromate neurosurgical robot has been validated in vitro but has not been evaluated in vivo for deep brain stimulation (DBS) electrode implantations. The authors conducted a study to evaluate this application accuracy in routine frame-based DBS procedures, with an independent sys...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.9.JNS14256
更新日期:2015-01-01 00:00:00
abstract::Primary leptomeningeal gliomatosis is rare, and the diffuse form is even rarer with only three cases reported in the literature. A fourth case is described in this report. Computerized tomography (CT) findings showed hydrocephalus with enhancement of the cerebral cisterns, and analysis of cerebrospinal fluid obtained ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1985.63.2.0283
更新日期:1985-08-01 00:00:00
abstract::OBJECTIVEDifferent CSF diversion procedures (ventriculoperitoneal, ventriculoatrial, and lumboperitoneal shunting) have been utilized for the treatment of idiopathic normal pressure hydrocephalus. More recently, endoscopic third ventriculostomy has been suggested as a reasonable alternative in some studies. The purpos...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/2018.5.JNS1875
更新日期:2018-11-01 00:00:00
abstract::The complete avulsion of the brachial plexus is a severe injury usually caused by high-energy trauma. Even with the advent of modern microsurgical techniques, many patients have been rendered severely handicapped following this injury. The authors present a new reconstructive procedure that uses a microsurgical reinne...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1996.85.1.0174
更新日期:1996-07-01 00:00:00
abstract:OBJECT:The goal of this study was to quantify volumetrically cement fill and leakage in patients with osteoporotic and metastatic vertebral lesions undergoing percutaneous vertebroplasty and to establish whether these factors have any clinical significance at follow up. METHODS:Digital computerized tomography data wer...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2003.99.1.0056
更新日期:2003-07-01 00:00:00
abstract::Although they are excellent clinical tools, Caspar anterior cervical plates have not been studied closely with regard to their mechanisms of failure. As more extensive operations are contemplated on older, sicker patients, it is imperative to know when a plating system might be prone to failure and what the mechanism ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1996.84.6.0957
更新日期:1996-06-01 00:00:00
abstract::OBJECTIVE Direct and indirect bypass surgeries are recognized as the most effective treatments for preventing further stroke in adults with moyamoya disease (MMD). However, the risk factors for postoperative infarction after bypass surgery for MMD are not well established. Therefore, the objective of this study was to...
journal_title:Journal of neurosurgery
pub_type: 评论,杂志文章
doi:10.3171/2016.3.JNS152256
更新日期:2017-05-01 00:00:00
abstract::Tandem internal carotid artery (ICA) origin occlusion and middle cerebral artery (MCA) thromboembolism is a life-threatening condition with poor neurological outcome. The authors report on a patient presenting with acute ischemic stroke from a tandem ICA and MCA occlusion with penumbra. Emergency MCA mechanical thromb...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.6.JNS162368
更新日期:2018-09-01 00:00:00
abstract::The authors report results obtained in 20 severely affected patients with Parkinson's disease (Grade IV or V) who received an autotransplant of perfused adrenal medullary tissue. This study seems to indicate that these autoimplants can improve the parkinsonian symptomatology and induce amelioration in the patients' pe...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1991.75.2.0234
更新日期:1991-08-01 00:00:00
abstract::Tail-like caudal appendages may be associated with spinal dysraphism, particularly with spinal lipomas or lipomyelomeningoceles. An unusual case is presented of a patient with a myelomeningocele and a thick filum terminale with tethered spinal cord, which presented with the external appearance of a human tail. A revie...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1993.78.6.0966
更新日期:1993-06-01 00:00:00
abstract::The authors used indicator fractionation techniques to determine blood flow in normal and bluntly traumatized spinal cords of Macaca rhesus monkeys. Normal flow rates were determined for several levels of spinal cord as well as differential values for white and gray matter from representative areas. Flow rates in trau...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1975.43.2.0162
更新日期:1975-08-01 00:00:00
abstract::A 12-year operative experience with 171 consecutive patients with severe brachial plexus lesions who had at least 1 1/2 years of follow-up review is analyzed. Selection for and timing of operation was helped by categorization of each individual plexus element as "completely" or "incompletely" injured and as "in contin...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.58.5.0631
更新日期:1983-05-01 00:00:00
abstract:OBJECT:The aim of this anatomical study was to define more fully the three-dimensional (3D) relationships between the optic radiations and the temporal horn and superficial anatomy of the temporal lobe by using the Klingler white matter fiber dissection technique. These findings were correlated with established surgica...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2004.101.5.0739
更新日期:2004-11-01 00:00:00
abstract::OBJECTIVE Over the last half century, there have been isolated case reports of purely arterial malformations. In this study, the authors report a consecutive series of patients with pure arterial malformations, emphasizing the clinical and radiological features of these lesions. METHODS Pure arterial malformations wer...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.2.JNS1744
更新日期:2018-07-01 00:00:00
abstract::The authors have designed an experiment to detect a hitherto unrecognized interaction between high doses of the glucocorticoid, dexamethasone, and brain irradiation. Eighteen juvenile male rhesus monkeys received 1800 rads to the whole brain in 8.5 minutes. For 1 1/2 days before and 10 1/2 days after the irradiation, ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1979.51.5.0587
更新日期:1979-11-01 00:00:00
abstract:OBJECT:The aim of this study was to investigate potential episodes of cerebral ischemia during surgery for large and complicated aneurysms, by examining the effects of arterial temporary clipping and the impact of confounding variables such as blood pressure and cerebrospinal fluid (CSF) drainage. METHODS:Brain tissue...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.2002.96.6.1013
更新日期:2002-06-01 00:00:00
abstract:OBJECT:Intraoperative neurophysiological monitoring (IONM) represents an established tool in neurosurgery to increase patient safety. Its application, however, is controversial. Its use has been described as helpful in avoiding neurological deterioration during intracranial aneurysm surgery. Its impact on extracranial-...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2013.4.JNS122205
更新日期:2013-07-01 00:00:00
abstract::The Department of Neurosurgery at the University of Rochester has a long legacy of excellent patient care and innovation in the neurosciences. The department's founder, Dr. William Van Wagenen, was a direct pupil of Harvey Cushing and the first president of the Harvey Cushing Society. His successor, Dr. Frank P. Smith...
journal_title:Journal of neurosurgery
pub_type: 历史文章,杂志文章
doi:10.3171/2014.7.JNS132658
更新日期:2014-10-01 00:00:00
abstract::This review was undertaken to determine the efficacy of using dorsal root entry zone (DREZ) lesions to treat intractable pain caused by trauma to the conus medullaris and cauda equina. Traumatic lesions of this area are unique in that both the spinal cord and the peripheral nerve roots are injured. Although DREZ lesio...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.82.1.0028
更新日期:1995-01-01 00:00:00
abstract::The clinical and pathological data of 66 patients with orbital cavernous hemangioma are presented. This tumor occurs in females more frequently than in males, and has its peak incidence in early middle age. Visual disability results from a high degree of relative hyperopia or from optic-nerve compression. Postural or ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1979.51.2.0219
更新日期:1979-08-01 00:00:00
abstract::Massive osteolysis is a type of idiopathic osteolysis in which there is spontaneous onset of bone resorption. Almost any bone in the body can be affected. The authors present the case of a 62-year-old man diagnosed with massive osteolysis of the occipital bone and the upper two cervical vertebrae. Despite extensive pn...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.1997.87.5.0773
更新日期:1997-11-01 00:00:00
abstract::Arteriovenous malformations (AVM's) of lateral and sigmoid sinuses are acquired lesions evolving from a previously thrombosed dural sinus. Their natural history is usually that of gradual progression and hence surgery is frequently necessary. The preferred surgical treatment is complete excision coupled with packing o...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.59.1.0032
更新日期:1983-07-01 00:00:00
abstract:OBJECT:Intracranial germinomas commonly occur in the pineal region, the floor of the third ventricle (hypothalamus), or both, and they are often associated with diabetes insipidus (DI). The authors conducted a study to correlate preoperative DI with the endoscopic and magnetic resonance (MR) imaging evidence of tumor o...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2004.100.5.0430
更新日期:2004-05-01 00:00:00
abstract::The successful use of autogenous skull bone grafts for a C3-7 anterior cervical fusion is reported and compared with results using other bone grafts. A 51-year-old man with C4-7 anterior cord compression due to spurs and ossified posterior longitudinal ligaments developed progressive tetraparesis following a minor hea...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1992.76.2.0298
更新日期:1992-02-01 00:00:00
abstract::Mannitol is widely considered the hyperosmolar therapy of choice in routine neurosurgical practice for the reduction of intracranial pressure (ICP). The authors present a unique case of a patient with a large meningioma treated with mannitol, in which mannitol accumulation within the tumor and its surrounding parenchy...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/108/5/1010
更新日期:2008-05-01 00:00:00
abstract::The surgical treatment of cerebrovascular malformations intrigued early neurosurgeons. Cushing defined vascular malformations as tumors arising from cerebral blood vessels. He successfully resected the first arteriovenous malformation 3 years after it had been irradiated. In the absence of angiography, the pathoanatom...
journal_title:Journal of neurosurgery
pub_type: 传,历史文章,杂志文章
doi:10.3171/jns.2004.101.3.0553
更新日期:2004-09-01 00:00:00
abstract::A survey of 89 patients with subdural empyema was conducted to assess the incidence of late seizures and morbidity in this disease. Twenty-four patients died during the acute stage of the illness and, of the 65 survivors, 13 were lost or had incomplete follow-up review. Hemiparesis occurred in 48 of the survivors duri...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.58.4.0569
更新日期:1983-04-01 00:00:00
abstract:OBJECTIVE:Surgical revascularization is known to reduce the incidence of further ischemic and hemorrhagic events in patients with moyamoya disease, but the majority of previous studies report only short-term (< 5 years) outcomes. Therefore, in this study the authors aimed to evaluate late (5-20 years) outcomes of moyam...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2019.12.JNS192938
更新日期:2020-03-13 00:00:00
abstract:OBJECT:Retrochiasmatic craniopharyngiomas are surgically challenging tumors. Retrochiasmatic craniopharyngiomas with complicated conditions such as large diameter, major calcification, or significant extension to the third ventricle or posterior fossa present surgical challenges; moreover, recurrent retrochiasmatic cra...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2013.10.JNS13673
更新日期:2014-01-01 00:00:00
abstract:OBJECT:Expression of matrix metalloproteinases (MMPs) has been postulated to play a central role in brain tumor invasion; however, its underlying mechanism is not yet fully understood. In the present study, by assessing the effect of a specific p38 mitogen-activated protein kinase (MAPK) inhibitor, SB203580, on the sec...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2002.97.1.0112
更新日期:2002-07-01 00:00:00