Surgery

Magnetic resonance perfusion for differentiating low-grade from high-grade gliomas at first presentation

Abstract Background Gliomas are the most common primary brain tumour. They are graded using the WHO classification system, with Grade II-IV astrocytomas, oligodendrogliomas and oligoastrocytomas. Low-grade gliomas (LGGs) are WHO Grade II infiltrative brain tumours that typically appear solid and non-enhancing on magnetic resonance imaging (MRI) scans. People with LGG often have little or no […]

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Intraoperative imaging technology to maximise extent of resection for glioma

Abstract Background Extent of resection is considered to be a prognostic factor in neuro-oncology. Intraoperative imaging technologies are designed to help achieve this goal. It is not clear whether any of these sometimes very expensive tools (or their combination) should be recommended as standard care for people with brain tumours. We set out to determine […]

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Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults

Abstract Background Various techniques have been employed for the early detection of perioperative cerebral ischaemia and hypoxia. Cerebral near-infrared spectroscopy (NIRS) is increasingly used in this clinical scenario to monitor brain oxygenation. However, it is unknown whether perioperative cerebral NIRS monitoring and the subsequent treatment strategies are of benefit to patients. Objectives To assess the […]

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External drains versus no drains after burr-hole evacuation for the treatment of chronic subdural haematoma in adults

Abstract Background Chronic subdural haematoma (CSDH) is one of the most common types of intracranial haematoma, and often occurs in older people. Burr-hole craniostomy, which is an evacuation through one or two burr holes drilled over the site of the haematoma, has been widely accepted as the most effective way to manage CSDH. Recurrences are […]

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Interventions for idiopathic intracranial hypertension

Abstract Background Idiopathic intracranial hypertension (IIH) has an estimated incidence of one to three people per 100,000 people per year, and occurs most commonly in obese, young women. IIH is associated with severe morbidity, notably due to a significant threat to sight and severe headache. Several different management options have been proposed. Conservative measures centre […]

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Endoscopic third ventriculostomy (ETV) for idiopathic normal pressure hydrocephalus (iNPH)

Abstract Background Idiopathic normal pressure hydrocephalus (iNPH) is a type of communicating hydrocephalus also known as non-obstructive hydrocephalus. This type of hydrocephalus is caused by impaired cerebrospinal fluid reabsorption without any obstruction in the ventricular system and is associated with normal cerebrospinal fluid pressure. It is characterised clinically by gait disturbance, cognitive dysfunction, and urinary […]

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Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy

Abstract Background Patients with brain tumour usually suffer from increased pressure in the skull due to swelling of brain tissue. A swollen brain renders surgical removal of the brain tumour difficult. To ease surgical tumour removal, measures are taken to reduce brain swelling, often referred to as brain relaxation. Brain relaxation can be achieved with […]

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Flow-regulated versus differential pressure-regulated shunt valves for adult patients with normal pressure hydrocephalus

Abstract Background Since 1965 many ventriculo-peritoneal shunt systems have been inserted worldwide to treat hydrocephalus. The most frequent indication in adults is normal pressure hydrocephalus (NPH), a condition that can be difficult to diagnose precisely. Surgical intervention with flow-regulated and differential pressure-regulated ventriculo-peritoneal shunts remains controversial. Knowledge about the benefits and harms of these interventions […]

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Biopsy versus resection for the management of low-grade gliomas

Abstract Background Low-grade gliomas (LGG) constitute a class of slow-growing primary brain neoplasms. Patients with clinically and radiographically suspected LGG have two initial surgical options, biopsy or resection. Biopsy can provide a histological diagnosis with minimal risk but does not offer a direct treatment. Resection may have additional benefits such as increasing survival and delaying […]

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Surgical resection and whole brain radiation therapy versus whole brain radiation therapy alone for single brain metastases

Abstract Background The treatment of brain metastasis is generally palliative since most patients have uncontrollable systemic cancer. Historically, whole brain radiation therapy (WBRT) has been the treatment of choice, although more recently focused radiation therapy e.g. stereotactic radiosurgery (SRS) has developed a role in selected patients. In certain circumstances, such as single brain metastasis, death […]

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