Neurosurgery
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A retrospective review of 373 adult patients admitted to Harbor General Hospital between 1980 and 1984 for minor closed head injury (Glasgow coma scale 13-15) was performed to determine the benefits of skull radiography, computed tomographic (CT) scanning of the head, and admission for observation. Variables reviewed were mental status, neurological examination, presence or absence of loss of consciousness, clinical evidence of basilar skull fracture, and fracture on skull radiography. The neurological examination (including mental status and Glasgow coma scale) in the emergency room was the best predictor of subsequent deterioration or the presence of an operative hematoma. ⋯ If no operative lesion is found on the CT scan, the patient should be admitted for observation because there is still a risk of deterioration. Those with a Glasgow coma scale score of 15, a normal mental status, and no hemispheric neurological deficit may be discharged to be observed at home by a competent observer despite basilar or calvarial skull fracture, loss of consciousness, or cranial nerve deficit. No benefit was gained from skull radiography in any group.
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Advances in microsurgical techniques combined with a widening interest in same-day surgery led us to investigate ambulatory lumbar discectomy. We could find no precedent in the literature. Ten patients with classic ruptured lumbar discs confirmed by computed tomography chose to participate. ⋯ All returned to their usual occupation between 3 and 14 days postoperatively. All were satisfied and would choose the outpatient program again. Our experience indicates that ambulatory lumbar microdiscectomy can be a safe, effective option for selected patients.
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Thirteen patients harboring large petroclival meningiomas are reported. The evolution of the petrosal approach is discussed, and modifications for improvement in surgical technique are described. There was no mortality in this series, and total removal was achieved in all but two patients. Morbidity included cranial nerve deficit, pulmonary embolism, and hemiparesis.