In this series of patients with glioblastoma, age was a prognostic factor in patients undergoing biopsy, but not in patients undergoing resection. Tumor location and patient clinical status may prohibit extensive resection, but resection should not be withheld from patients only on the basis of age. In elderly patients with glioblastoma, undergoing resection to the extent feasible, followed by adjuvant therapies, is warranted.

Clipping of a ruptured aneurysm may be associated with a lower risk for developing shunt dependency, possibly by clot removal. This might influence long-term outcome and surgical decision making.

ENINGIOMAS are typically benign, slowly growing tumors. Despite the fact that their histogenesis is unclear, it is thought that arachnoidal cells are the most likely origin of these lesions. 20 Meningiomas account for 13 to 19% of all intracranial tumors. 35,45 Spinal meningiomas represent 12% of all meningiomas 31 and 25 to 45% of intradural spine tumors. 14 Spinal meningiomas lead to chronic spinal cord compression and myelopathy. Treatment is predominantly surgical. Previously published data indicate mostly favorable outcomes; however, progressive spinal cord compression due to a spinal meningioma can lead to neurological deterioration that, at times, can result in a permanent deficit even after successful surgery.

The present data indicate that ONP caused by PComA aneurysms resolves in a significantly higher portion of patients after surgical treatment compared with endovascular coiling and the spontaneous course.

Background and Purpose-The clinical significance of sentinel headaches in patients with subarachnoid hemorrhage (SAH) is still unknown. We investigated whether patients with a sentinel headache (SH) have a higher rate of rebleeding after SAH. Methods-An SH was defined as a sudden, severe, unknown headache lasting Ͼ1 hour with or without accompanying symptoms, not leading to a diagnosis of SAH in the 4 weeks before the index SAH. Age, sex, smoking status, clinical grade, computed tomography (CT) findings, angiographic findings, placement of an external ventricular drain, and time to aneurysm obliteration were prospectively recorded. All rebleeding events were confirmed by CT. Outcome was assessed at 6 months according to the modified Rankin Scale. Results-Of 237 consecutive patients with SAH, 41 (17.3%) had an SH. Rebleeding occurred in 23 (9.7%) of all patients.Patients with an SH had a 10-fold increased odds of rebleeding compared with patients without SH. Aneurysm size and the total number of aneurysms were also significantly associated with rebleeding. There were no differences in age, sex, smoking, CT or angiographic findings, external ventricular drain placement, or time to aneurysm obliteration between groups. Patients with rebeeding had a significantly worse outcome. Logistic regression revealed the presence of an SH as an independent risk factor for rebleeding. Conclusions-In our study, patients with SAH who had an SH constituted a special group of patients with a 10-fold odds for early rebleeding. The presence of an SH may select candidates for ultraearly aneurysm obliteration or drug treatment.