Journal of neurosurgery
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Journal of neurosurgery · Dec 2007
New transparent peel-away sheath with neuroendoscopic orientation markers. Technical note.
The peel-away sheath in neuroendoscopic surgery offers numerous advantages and has many potential applications. However, currently available nontransparent sheaths have a critical disadvantage in that disorientation can occur, given the limited visible operative field. To overcome this obstacle, the authors have developed and clinically applied a new transparent sheath with "navigational orientation markers." The clear peel-away sheath provides a transparenchymal route, parenchymal protection, and, most importantly, direct visualization of the surroundings along the whole trajectory and at the distal edge. The navigational orientation markers add further benefits in terms of facilitating orientation in the endoscope trajectory, making this tool extremely useful in neuroendoscopic surgery.
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Journal of neurosurgery · Dec 2007
Persistent perioperative hyperglycemia as an independent predictor of poor outcome after aneurysmal subarachnoid hemorrhage.
The authors of previous studies have shown that admission hyperglycemia or perioperative hyperglycemic events may predispose a patient to poor outcome after aneurysmal subarachnoid hemorrhage (SAH). The results of experimental evidence have suggested that hyperglycemia may exacerbate ischemic central nervous system injury. It remains to be clarified whether a single hyperglycemic event or persistent hyperglycemia is predictive of poor outcome after aneurysmal SAH. ⋯ Patients with persistent hyperglycemia were seven times more likely to have a poor outcome at a mean of 10 months after aneurysmal SAH. Isolated hyperglycemic events were not predictive of poor outcome. Serum glucose levels in the acute setting of aneurysmal SAH may help predict outcomes months after surgery.
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Journal of neurosurgery · Dec 2007
Preservation of a subcutaneous pocket for vagus nerve stimulation pulse generator during magnetoencephalography. Technical note.
Patients with epilepsy and an implanted vagus nerve stimulation (VNS) device who are referred for consideration of definitive epilepsy surgery (removal of the epileptogenic cortex) may require magnetoencephalography (MEG), a study requiring explantation of the pulse generator, as part of their evaluation. Nonetheless, these patients may not wish to abandon palliative VNS therapy should definitive surgery prove unsuccessful or impossible. ⋯ Upon completion of MEG, if pulse generator replacement proves desirable, atraumatic retrieval of the electrode connector pin and body is easy. Silicone block implantation during what may prove to be temporary device explantation facilitates reuse of the original pulse generator implantation site and atraumatic distal electrode wire retrieval.
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Journal of neurosurgery · Dec 2007
Naval aviation and neurosurgery: traditions, commonalities, and lessons learned. The 2007 presidential address.
In his presidential address to the American Association of Neurological Surgeons, the author recounts lessons he learned while training to be a Naval Aviator and later a neurosurgeon. He describes his life as an aviator and neurosurgeon, compares naval aviation and neurosurgery, and points out lessons that neurosurgery can learn from naval aviation.