Abstract:
OBJECT:Surgical mortality is a frequent outcome measure in studies of volume-outcome relationships, and the Agency for Healthcare Research and Quality has endorsed surgical mortality after craniotomies as an Inpatient Quality Indicator. Still, the frequency and causes of 30-day mortality after neurosurgical procedures have not been much explored. The authors sought to study the frequency and possible causes of death following primary intracranial tumor operations. They also sought to explore a possible predictive value of perioperative mortality rates from neurosurgical centers in relation to long-term survival. METHODS:Using population-based data from the Norwegian cancer registry, the authors identified 15,918 primary operations for primary CNS tumors treated in Norway in the period from August 1955 through December 2008. Patients were followed up until death, emigration, or September 2009. Causes of mortality as indicated on death certificates were studied. Factors associated with an increased risk of perioperative death were identified. RESULTS:The overall risk of perioperative death after first-time surgery for primary intracranial tumors is currently 2.2% and has decreased over the last decades. An age ≥ 70 years and histopathological entities with poor long-term prognoses are risk factors. Overlapping lesions are also associated with excess risk, indicating that lesion size or multifocality may matter. The overall risk of perioperative death is also higher in biopsy cases than in resection cases. Perioperative mortality rates of the 4 Norwegian neurosurgical centers were not predictive of their respective long-term survival rates. CONCLUSIONS:Although considered surgically related if they occur within the first 30 days of surgery, most early postoperative deaths can happen independent of the handiwork of the operating surgeon or anesthesiologist. Overall prognosis of the disease seems to be a strong predictor of perioperative death-perhaps not surprisingly since the 30-day mortality rate is merely the intonation of the Kaplan-Meier curve. Both referral and treatment policies at a neurosurgical center will therefore markedly affect such early outcomes, but early deaths may not necessarily reflect overall quality of care or long-term results. The low incidence of perioperative death in intracranial tumor surgery also greatly limits the statistical power in comparative analyses, such as between published patient series or between centers and certainly between surgeons. Therefore the authors question the value of perioperative mortality rates as a quality indicator in modern neurosurgery for tumors.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Solheim O,Jakola AS,Gulati S,Johannesen TBdoi
10.3171/2011.12.JNS11339subject
Has Abstractpub_date
2012-04-01 00:00:00pages
825-34issue
4eissn
0022-3085issn
1933-0693journal_volume
116pub_type
杂志文章abstract::A study was designed to investigate hyperperfusion syndrome after the restoration of normal cerebral blood flow in a chronically cerebral ischemic state resulting from high-flow arteriovenous malformations or severe carotid stenosis. A fistula between the left distal common carotid artery and the jugular vein was crea...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1992.76.3.0478
更新日期:1992-03-01 00:00:00
abstract::The authors present a case of chordoid meningioma in a 55-year-old woman who manifested headache and personality change. Magnetic resonance imaging of the brain and cerebral angiography demonstrated a mass in the right frontal lobe that resembled a typical convexity meningioma. However, the pathological diagnosis was ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.2001.94.1.0122
更新日期:2001-01-01 00:00:00
abstract::The commonest initial computerized tomography (CT) finding in head-injured children is bilateral diffuse cerebral swelling. Cerebral blood flow and CT density studies suggest that this swelling is due to cerebral hyperemia and increased blood volume, not to edema. The clinical history, course, and outcome of 63 childr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1981.54.2.0170
更新日期:1981-02-01 00:00:00
abstract::The angiographic appearance of an intracranial arterial occlusion is typically distinct from that of a saccular aneurysm, with only a few reported cases of occlusion simulating aneurysm. At the same time, a small percentage of symptomatic intracranial aneurysms present with a stroke. Accurate diagnosis of these condit...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS.2008.109.12.1123
更新日期:2008-12-01 00:00:00
abstract::An intraventricular glioma occupying all four ventricles of the brain in children is very uncommon. The authors report a unique case of a tetraventricular Grade II astrocytoma with evidence of extension into the basal cisterns in a 5-year-old boy who had a 1-month history of headache. There was no neurological deficit...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2007.106.2.134
更新日期:2007-02-01 00:00:00
abstract::OBJECTIVE Mineralized or desiccated colloid cysts pose some unique challenges to endoscopic removal. The extrusion of the solid matrix into the intraventricular compartment has not been previously reported and, as such, no guidance exists regarding its predilection, prevention, and fate. METHODS Postoperative imaging ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.6.JNS142676
更新日期:2016-09-01 00:00:00
abstract::Dorsal root entry zone lesions have been documented as effective for control of intractable pain in patients with brachial plexus avulsion or severe spinal cord injury. These lesions are usually made with the radiofrequency technique. The authors report three cases in which the CO2 laser was used as an alternative mea...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.59.5.0884
更新日期:1983-11-01 00:00:00
abstract:OBJECT:Gamma knife surgery (GKS) has been a safe and effective treatment for vestibular schwannomas in both the short and long term, although less is known about long-term outcomes in the past 10 years. The aim of this study was to clarify long-term outcomes in patients with vestibular schwannomas treated using GKS bas...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2005.102.1.0010
更新日期:2005-01-01 00:00:00
abstract::Chordoid meningioma is a rare meningothelial tumor characterized by chordoma-like histological features with lymphoplasmacellular infiltration. This tumor is often seen in children, but not in adults, with a systemic inflammatory syndrome (iron-resistant microcytic anemia and/or dysgammaglobulinemia) and very rarely w...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2005.103.3.0555
更新日期:2005-09-01 00:00:00
abstract:OBJECT:Preoperative clinical risk classification of carotid artery (CA) stenosis anticipates the outcome of CA intervention. A higher incidence of neurological morbidity was noted after CA stenting (CAS) in patients with medical risks than in those without risks. However, little is known about the correlation between c...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2010.8.JNS10423
更新日期:2011-04-01 00:00:00
abstract:OBJECT:Surgery in the insular region is considered challenging because of its vascular relationships, the proximity of functional structures, and its deep location in the sylvian fissure. The authors report the incidence and consequences of ischemic lesions after operculoinsular corticectomy for refractory epilepsy. M...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.10.JNS141246
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVE:The present study was designed to explore the association between facility type (academic center [AC] vs non-AC), facility volume (high-volume facility [HVF] vs low-volume facility [LVF]), and outcomes of glioblastoma (GBM) treatment. METHODS:Based on the National Cancer Database (NCDB), GBM patients were ca...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2018.10.JNS182247
更新日期:2019-02-15 00:00:00
abstract:OBJECT:The authors of this study aimed to genetically design a bispecific targeted toxin that would simultaneously target overexpressed markers on glioma as well as the tumor vasculature, to mutate certain amino acids to reduce the immunogenicity of this new drug, and to determine whether the drug was able to effective...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2010.11.JNS101214
更新日期:2011-06-01 00:00:00
abstract::One hundred and thirty-three patients with chronic subdural hematoma were treated surgically between 1943 and 1980. The patients, aged 5 to 84 years, were graded retrospectively according to the Bender scale; 28% were in Grades 3 and 4. There were 107 unilateral and 26 bilateral hematomas. The clots were removed mostl...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.61.2.0263
更新日期:1984-08-01 00:00:00
abstract:OBJECTIVE:Hemifacial spasm (HFS) is characterized by involuntary tonic and/or clonic contractions of facial nerve muscles. Fully endoscopic microvascular decompression (E-MVD) for HFS has not been widely adopted. This paper aims to illustrate the safety and efficacy of the fully endoscopic technique for HFS treatment. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2018.4.JNS172631
更新日期:2018-10-05 00:00:00
abstract::The intracranial pressure-volume (PV) relationship was examined postoperatively after removal of brain tumors in two groups of patients (13 in all). Changes of ventricular fluid pressure were analyzed by a method involving fluid injection into the lateral ventricle. A technique has been developed which provides quanti...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1982.57.4.0500
更新日期:1982-10-01 00:00:00
abstract::The authors have reviewed the clinical records of 110 patients with intracranial cavernous malformations diagnosed by histological examination and/or magnetic resonance imaging over a mean follow-up period of 4.71 years. These cases were divided, based on their presentation, into a hemorrhage group, a seizure group, a...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.83.1.0056
更新日期:1995-07-01 00:00:00
abstract:OBJECT:Changes in cortical representation in patients with cerebral lesions may alter the correlation between cortical anatomy and function. This is of potential clinical significance when the extent of cortical resection is based on surface anatomical landmarks. METHODS:Fifty-one patients with supratentorial lesions ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2000.92.2.0242
更新日期:2000-02-01 00:00:00
abstract:OBJECT:Prior attempts to define normal cerebellar tonsil position have been limited by small numbers of patients precluding analysis of normal distribution by age group. The authors' objective in the present study was to analyze cerebellar tonsil location in every age range. METHODS:Two thousand four hundred patients ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2013.5.JNS121825
更新日期:2013-09-01 00:00:00
abstract::Pineal region tumors pose certain challenges in regard to their resection: a deep surgical field, associated critical surrounding neurovascular structures, and narrow operative working corridor due to obstruction by the apex of the culmen. The authors describe a lateral supracerebellar infratentorial approach that was...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.2.JNS142088
更新日期:2016-01-01 00:00:00
abstract::OBJECTIVE The pathophysiological mechanisms responsible for the formation of intracranial aneurysms (IAs) remain only partially elucidated. However, current evidence suggests a genetic component. The purpose of this study was to investigate the specific anatomical variations in the arterial complex that are associated...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.3171/2016.4.JNS153032
更新日期:2017-05-01 00:00:00
abstract::Chiasmatic optic glioma is a rare tumor with an erratic natural history, usually seen in young children. A prior study from this institution demonstrated that these lesions were frequently lethal, despite initial clinical stabilization following radiation therapy, and that visual, intellectual, and late endocrinologic...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1985.63.6.0862
更新日期:1985-12-01 00:00:00
abstract:OBJECT:Chiari malformation Type I (CM-I) is characterized by hindbrain deformity. We investigated the effects of craniocervical decompression surgery on the anatomical features of hindbrain deformity with a prospective MRI study of patients with CM-I. METHODS:A prospective longitudinal study was conducted in 48 patien...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2012.8.JNS111476
更新日期:2012-11-01 00:00:00
abstract:OBJECT:Frontal lobe epilepsy (FLE) is the second-most common focal epilepsy syndrome, and seizures are medically refractory in many patients. Although various studies have examined rates and predictors of seizure freedom after resection for FLE, there is significant variability in their results due to patient diversity...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,meta分析,评审
doi:10.3171/2012.1.JNS111620
更新日期:2012-05-01 00:00:00
abstract:OBJECT:The aim of this prospective study was to evaluate the phagocytic, humoral, and cellular arms of the immune system in comatose patients shortly after severe brain injury and to compare the findings with those reported earlier in patients in a persistent vegetative state. The study was conducted in intensive care ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2001.94.5.0706
更新日期:2001-05-01 00:00:00
abstract::The authors report a case of craniopharyngioma presenting in the right cerebellopontine angle. The tumor was removed totally. The purpose of this report is to record this very unusual localization of a craniopharyngioma. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.60.4.0842
更新日期:1984-04-01 00:00:00
abstract::A retrospective series of 12,478 patients with breast cancer included 2467 patients with spinal metastases. Local treatment was not necessary in 688 patients. Neurological dificit did not develop in 1735 patients who underwent radiotherapy. Forty-four patients developed myelopathy due to spinal cord compression as dem...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.47.5.0653
更新日期:1977-11-01 00:00:00
abstract::The relationship between neuropsychological deficit and emotional disturbance was examined in a sample of 124 patients who sustained work-related head injuries. Most injuries met criteria for minor head injury. Since all patients were receiving compensation, the relationship between emotional disturbance and neuro-beh...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1989.70.4.0509
更新日期:1989-04-01 00:00:00
abstract:OBJECT:Insular gliomas can be resected with acceptable rates of neurological morbidity, but little is known with regard to impairment of higher-order neurocognitive functions. The frequency and functional impact of neurocognitive deficits in patients with gliomas has until recently been underappreciated. The authors th...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2011.8.JNS11488
更新日期:2011-12-01 00:00:00
abstract::The effect of intravenous nimodipine on the incidence of mortality and delayed ischemic neurological deficits of patients after aneurysmal subarachnoid hemorrhage (SAH) and surgery was studied in a prospective double-blind placebo-controlled trial. Upon admission, all of the patients were in Grades I to III according ...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.1988.69.5.0683
更新日期:1988-11-01 00:00:00