Journal of neurosurgery
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Journal of neurosurgery · Sep 2002
Outcome in neurologically impaired patients with craniovertebral junction tuberculosis: results of combined anteroposterior surgery.
The authors studied the immediate and long-term outcome after transoral decompression, occipitocervical fusion, and antituberculous therapy (ATT) in patients who had neurological deficits due to craniovertebral junction (CVJ) tuberculosis. ⋯ Patients with CVJ tuberculosis with features of cervical myelopathy are ideally managed with transoral decompressive procedures followed by occipitocervical fusion because this therapy provides immediate neurological improvement, stability, and allows early mobilization. The long-term prognosis in patients with this disease is excellent provided it is treated with appropriate surgical intervention(s) and with adequate duration of ATT.
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Journal of neurosurgery · Sep 2002
Biography Historical ArticleCalifornia's Cushing connection: Harvey Cushing trained California's first neurosurgeons.
On September 9, 2000, California celebrated its sesquicentennial anniversary of its admission to the United States. One hundred years ago, in September of 1901, Harvey Cushing began his surgical practice in Baltimore, Maryland. ⋯ Cushing--Howard Naffziger, Carl Rand, and Edward Towne--who played defining roles in establishing modern neurosurgery in the Golden State. In promulgating Cushing's surgical principles and philosophy, these physicians achieved a distinguished place in the history of medicine in California.
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Journal of neurosurgery · Aug 2002
Comparative StudyPredicting recovery in patients suffering from traumatic brain injury by using admission variables and physiological data: a comparison between decision tree analysis and logistic regression.
Decision tree analysis highlights patient subgroups and critical values in variables assessed. Importantly, the results are visually informative and often present clear clinical interpretation about risk factors faced by patients in these subgroups. The aim of this prospective study was to compare results of logistic regression with those of decision tree analysis of an observational, head-injury data set, including a wide range of secondary insults and 12-month outcomes. ⋯ Decision tree analysis confirmed some of the results of logistic regression and challenged others. This investigation shows that there is knowledge to be gained from analyzing observational data with the aid of decision tree analysis.
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Journal of neurosurgery · Aug 2002
Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations.
Chronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a procedure that is rapidly gaining acceptance for the treatment of symptoms in patients with Parkinson disease (PD), but there are few detailed descriptions of the surgical procedure itself. The authors present the technical approach used to implant 76 stimulators into the STNs of patients with PD and the lead locations, which were verified on postoperative magnetic resonance (MR) images. ⋯ The authors' approach to implantation of DBS leads into the STN was associated with consistent lead placement in the dorsolateral STN, a low rate of morbidity, efficient use of operating room time, and robust improvement in motor function. The mean coordinates of the middle of the electrode array, measured on postoperative MR images, were 11.6 mm lateral, 2.9 mm posterior, and 4.7 mm inferior to the midcommissural point, and 6.5 mm lateral and 3.5 mm anterior to the center of the red nucleus. Voltage thresholds for several types of stimulation-induced adverse effects were predictive of lead location. Technical nuances of the surgery are described in detail.