Resection was traditionally considered the optimal treatment for patients with pituitary apoplexy. 8 , 12 , 13 , 31 , 34 However, more recent case series have reported good outcomes with conservative medical therapy. 9 , 21 , 23 , 24 No randomized studies have been conducted to compare the two management strategies, and guidelines propose individualizing therapy depending on the severity of presentation. 30 Most of the literature on pituitary apoplexy consists of relatively small case series. Very few series have included more than 50 patients and presented a long
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Tarun D. Singh, Navid Valizadeh, Fredric B. Meyer, John L. D. Atkinson, Dana Erickson, and Alejandro A. Rabinstein
Ron Gadot, A. Basit Khan, Rajan Patel, Eric Goethe, Arya Shetty, Caroline C. Hadley, James C. Bayley V, Akdes S. Harmanci, Tiemo J. Klisch, Daniel Yoshor, Sameer A. Sheth, and Akash J. Patel
M eningiomas are the most common primary intracranial tumor, accounting for approximately one-third of all CNS tumors. 1 , 2 Seizures are common sequelae of supratentorial meningioma development, with available data suggesting that 10%–40% of patients experience preoperative seizures. 3 – 9 Uncontrolled seizures are known to adversely affect a person’s quality of life and can lead to cognitive deterioration and require lifelong maintenance therapy with antiepileptic drugs (AEDs). 4 , 8 Resection can lead to demonstrably improved seizure outcomes, with
Scott L. Parker, Anthony L. Asher, Saniya S. Godil, Clinton J. Devin, and Matthew J. McGirt
of desired health outcomes.” 17 Safety and effectiveness (quality), patient-centered outcomes, as well as cost of care are each central components of the health care value equation (benefit/cost). The Institute of Medicine, Agency for Healthcare Research and Quality, and the Patient Protection and Affordable Care Act call for prospective, well-designed registries for the measurement of real-world effectiveness to facilitate evidence-based health care reform. Prospective registries are able to provide the necessary statistical power and real-world health delivery
Matthew J. McGirt, Theodore Speroff, Saniya Siraj Godil, Joseph S. Cheng, Nathan R. Selden, and Anthony L. Asher
US health care environment. The IOM defines health care quality as “The degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes.” 29 According to the IOM, quality care is safe, timely, efficient, patient centered, equitable, and effective. In the health care value equation (benefit/cost), effectiveness of care is the numerator and health care costs are the denominator. Without evidence of effectiveness, health care reform may reward cheaper care (cost-based purchasing) rather than more valuable care
Ranbir Ahluwalia, Jarrett Foster, Earllondra Brooks, Jaims Lim, Shilin Zhao, Stephen R. Gannon, Bradley Guidry, John Wellons III, and Chevis N. Shannon
C hiari type I malformation (CM-I) is the most common form of CM and is due to the downward displacement of the cerebellar tonsils through the foramen magnum. 1 , 23 Clinical presentations vary widely, but many patients have symptoms of obstructive hydrocephalus such as vision changes, nausea, and weakness, and most commonly headache and neck pain. 2 , 3 Although most studies show favorable surgical outcomes for CM-I in symptomatic patients, there are no established or clear indications for surgery aside from progressively worsening symptoms or presence of a
Tej D. Azad, Maziyar Kalani, Terrill Wolf, Alisa Kearney, Yohan Lee, Lisa Flannery, David Chen, Ryan Berroya, Matthew Eisenberg, Jon Park, Lawrence Shuer, Alison Kerr, and John K. Ratliff
D egenerative spine disease is a common and debilitating condition with significant economic costs. Direct medical costs due to low-back pain doubled to $102 billion between 1997 and 2005, 14 and the number of lumbar fusion procedures for degenerative lumbar disease has quadrupled in the past 20 years, resulting in increased health care spending. Some authors note that these increases in surgical procedures have not been matched by improved overall patient outcomes. 6 , 10 Although spine surgery has been shown to provide greater value for certain
Leland Rogers, Igor Barani, Marc Chamberlain, Thomas J. Kaley, Michael McDermott, Jeffrey Raizer, David Schiff, Damien C. Weber, Patrick Y. Wen, and Michael A. Vogelbaum
higher risk for tumor growth or symptom development, and whether long-term patient outcomes differ between surveillance and early definitive treatment. Many questions remain regarding the selection and timing of treatment, especially in cases of recurrent meningioma or newly diagnosed high-grade meningioma (WHO Grade II [atypical] or Grade III [malignant] meningioma). For patients undergoing definitive therapy, complete resection has been the standard for meningioma, but there is a significant subset of patients who are not successfully managed by surgery alone, or
Daniel A. Donoho, Timothy Wen, Jonathan Liu, Hosniya Zarabi, Eisha Christian, Steven Cen, Gabriel Zada, J. Gordon McComb, Mark D. Krieger, William J. Mack, and Frank J. Attenello
expertise through increased procedural volume, and the training and retention of specialists. 6 , 20 , 24 , 37 The National Association of Children’s Hospitals and Related Institutions (NACHRI) recognizes over 220 specialized pediatric hospitals. To date, no large-scale national studies have examined the effects of pediatric hospital designation on the outcomes of neurosurgical procedures for malignant pediatric brain tumors. For the purpose of assessing this relationship, a national database may be uniquely useful. The largest source of nationwide patient-level pediatric
Siri Sahib S. Khalsa, Alan Siu, Tiffani A. DeFreitas, Justin M. Cappuzzo, John S. Myseros, Suresh N. Magge, Chima O. Oluigbo, and Robert F. Keating
likelihood of clinical improvements. To answer this question, we aimed to develop a semiautomated 3D volume segmentation program that can be applied to both preoperative and postoperative anatomy. The goal was to efficiently quantify the preoperative and postoperative 3D volumes of the posterior cranial fossa (PCF) using brain MR images for a cohort of pediatric patients with CM-I. These volume changes of the posterior fossa after suboccipital decompression were compared with improvements in clinical and radiographic outcomes. Method Algorithm Overview The computer program
Allan R. Martin, Sukhvinder Kalsi-Ryan, Muhammad A. Akbar, Anna C. Rienmueller, Jetan H. Badhiwala, Jefferson R. Wilson, Lindsay A. Tetreault, Aria Nouri, Eric M. Massicotte, and Michael G. Fehlings
enrolled prospectively and categorized as having recurrent myelopathy if they had previously undergone surgery for DCM, and as having primary DCM otherwise. Subjects were then classified based on the management plan selected during the first clinic visit with their treating surgeon; those with initial nonoperative management were the focus of this study. Clinical outcomes were determined via retrospective chart reviews of clinic follow-up visits, based on the surgeon’s assessment of subjective and objective data. Treatment decisions were made based on established
