Journal of neurosurgery
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Journal of neurosurgery · Jan 2004
Case ReportsImproved repair of cervical esophageal fistula complicating anterior spinal fusion: free omental flap compared with pectoralis major flap. Report of four cases.
Esophageal injury is a serious complication of anterior cervical fusion. A team approach to the management of these cases is described. The authors performed spinal assessment, control of the fistula, and interposition of a vascularized flap between the spine and the esophagus. They compared the overall efficacy of the pectoralis major flap (pedicled; two cases) and omental flap (free; two cases).
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Journal of neurosurgery · Jan 2004
Comparative StudyMitomycin C in preventing spinal epidural fibrosis in a laminectomy model in rats.
Extensive epidural fibrosis after lumbar surgery may be the underlying cause in most cases of failed-back surgery syndrome. Various materials have been used to prevent epidural fibrosis, but only moderate success has been shown. Mitomycin C, an alkylosing antibiotic substance isolated from Streptomyces caespitosus, potentially supresses fibroblast proliferation after surgery. In this study, the authors investigated the effect of mitomycin C by local application on spinal epidural fibrosis in a rat laminectomy model. ⋯ In this experimental model, mitomycin C applied locally at a concentration of 0.1 mg/ml effectively reduced epidural fibrosis, completely avoided dural adherence, and induced no side effects.
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Journal of neurosurgery · Jan 2004
Proliferation, migration, and differentiation of human neural stem/progenitor cells after transplantation into a rat model of traumatic brain injury.
Cultures containing human neural stem and progenitor cells (neurospheres) have the capacity to proliferate and differentiate into the major phenotypes of the adult brain. These properties make them candidates for therapeutic transplantation in cases of neurological diseases that involve cell loss. In this study, long-term cultured and cryopreserved cells were transplanted into the traumatically injured rat brain to evaluate the potential for human neural stem/progenitor cells to survive and differentiate following traumatic injury. ⋯ This study shows that expandable human neural stem/progenitor cells survive transplantation, and migrate, differentiate, and proliferate in the injured brain. These cells could potentially be developed for transplantation therapy in cases of traumatic brain injury.
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Journal of neurosurgery · Jan 2004
ReviewSurgical innovation or surgical evolution: an ethical and practical guide to handling novel neurosurgical procedures.
Surgical innovation is an important driver of improvements in technique and technology, which ultimately translates into improvements in patients' outcomes. Nevertheless, patients may face new risks of morbidity and mortality when surgical innovation is used, and well-intentioned surgical "experimentation" on patients must be regulated and monitored. In this paper the authors examine the challenges of defining surgical innovation and briefly review the literature on this challenging subject. ⋯ The authors propose guidelines for determining the need for regulation of innovation. The potential role of institutional review boards in this process is highlighted.
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Journal of neurosurgery · Jan 2004
Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence.
The authors studied whether cervical spine motion segments adjacent to a fused segment exhibit accelerated degenerative changes on short-term follow-up magnetic resonance (MR) imaging. ⋯ On short-term follow-up MR imaging, levels adjacent to the fused segment exhibited more pronounced degenerative changes (compared with remote levels) in 75% of patients who had undergone one- or two-level central corpectomy.