Journal of neurosurgery
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Journal of neurosurgery · Oct 1995
Case Reports Comparative StudyEvaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results.
This study was undertaken to determine and compare indications and relative benefits of various surgical approaches in 170 patients (average age 55 years) with far-lateral herniated lumbar discs, identified by magnetic resonance (MR) imaging and computerized tomography (CT) and operated on between 1984 and 1994. Essentially three surgical procedures were performed: complete facetectomy in 73 patients, laminotomy with medial facetectomy in 39 patients, and intertransverse discectomy (also known as ITT) in 58 patients. Follow-up periods averaged 5 years (range 0.5-10 years). ⋯ Full facetectomy, laminotomy with medial facetectomy, and the intertransverse approaches yielded nearly comparable outcomes in far-lateral disc surgery. Only the full facetectomy exposes the entire course of the nerve root both medially and laterally, whereas the intertransverse procedure provides direct exposure of the fat-lateral compartment alone. It is important to select the correct approach or combination of approaches to address attendant complicating factors such as spinal stenosis, spondyloarthrosis, and degenerative spondylolisthesis identified on CT and MR studies.
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Journal of neurosurgery · Oct 1995
Biography Historical ArticleCase Western Reserve University and University Hospitals of Cleveland: a neurosurgical chronicle.
There is a strong tradition of neurosurgery in Cleveland. This article traces the origin of Case Western Reserve University School of Medicine and University Hospitals of Cleveland and examines the evolution of neurological surgery at these institutions. It looks at the strong Cushing influence on the process, by both Harvey Cushing and his family. The contributions of such luminaries as George Crile, Elliott Cutler, Claude Beck, and Frank Nulsen are described.
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Journal of neurosurgery · Oct 1995
Use of indomethacin in brain-injured patients with cerebral perfusion pressure impairment: preliminary report.
The effect of indomethacin, a cyclooxygenase inhibitor, was studied in the treatment of 10 patients with head injury and one patient with spontaneous subarachnoid hemorrhage, each of whom presented with high intracranial pressure (ICP) (34.4 +/- 13.1 mm Hg) and cerebral perfusion pressure (CPP) impairment (67.0 +/- 15.4 mm Hg), which did not improve with standard therapy using mannitol, hyperventilation, and barbiturates. The patient had Glasgow Coma Scale scores of 8 or less. Recordings were made of the patients' ICP and mean arterial blood pressure from the nurse's end-hour recording at the bedside, as well as of their CPP, rectal temperature, and standard therapy regimens. ⋯ The effects of standard therapy regimens before and during indomethacin infusion showed no significant changes, except in three patients in whom mannitol reestablished its action on ICP and CPP. Sudden discontinuation of indomethacin treatment was followed by significant ICP rebound. The authors suggest that indomethacin may be considered one of the frontline agents for raised ICP and CPP impairment.
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Journal of neurosurgery · Oct 1995
Comparative StudySpinal cord astrocytoma: pathological and treatment considerations.
Seventy-nine patients underwent surgery, with or without radiation therapy, for astrocytoma of the spinal cord. There were 43 tumors (54%) classified as pilocytic astrocytoma and 25 (32%) as diffuse fibrillary astrocytoma. Eleven tumors (14%) could not be classified other than as astrocytoma, "type not otherwise specified." The 10-year overall survival rate for all 79 patients was 50% but significantly differed by histological type: 81% for patients with pilocytic astrocytoma compared to 15% for those with diffuse fibrillary astrocytoma. ⋯ Postoperative radiation therapy improved survival but did so more for diffuse fibrillary astrocytoma than pilocytic astrocytoma. In this series, histological type was the most significant predictor of survival in patients with astrocytoma of the spinal cord. The survival rate was highest in patients who underwent biopsy followed by postoperative radiation therapy.
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Journal of neurosurgery · Oct 1995
Application of frameless stereotaxy to pedicle screw fixation of the spine.
Interactive frameless stereotaxy has been successfully applied to intracranial surgery. It has contributed to the improved localization of deep-seated brain lesions and has demonstrated a potential for reducing both operative time and morbidity. However, it has not been as effectively applied to spinal surgery. ⋯ One hundred forty-nine screws were assessed to be satisfactorily placed by postoperative CT and plain film radiography. In this report the authors discuss their use of this device in the clinical setting and review their preliminary results of frameless stereotaxy applied to spinal surgery. On the basis of their findings, the authors conclude that frameless stereotactic technology can be successfully applied to spinal surgery.