Neurosurgery
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The goal was to evaluate and describe the use of a frameless, computed tomography-guided, stereotactic technique in complex procedures involving the craniocervical junction. ⋯ Frameless stereotaxy provided the surgeon with intraoperative information regarding the extent of bone and soft tissue resection. It provided a multidimensional view of anatomic relationships in the operative field, which significantly increased surgical accuracy and safety.
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Spinal cord injury is one of several devastating complications after operation in the sitting position. Young patients exhibiting extraordinary growth spurts demonstrate a higher risk for this complication. ⋯ It is assumed that, in addition to head flexion, the abnormal skeletal growth spurt resulting from an excessive secretion of human chorionic gonadotropin from a tumor was a possible predisposing factor for this complication. To prevent this complication, surgeons need to pay great attention to head positioning, especially in a young patient experiencing an active growth spurt.
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We have developed a telemetric intracranial pressure sensor (OSAKA telesensor; Nagano Keiki Seisakusyo Co. Ltd., Tokyo, Japan) and investigated the clinical usefulness of new ventriculoperitoneal shunting with an OSAKA telesensor, an on-off valve, and a programmable valve. ⋯ The OSAKA telesensor is very useful in the postoperative care and pathophysiological evaluation of patients with hydrocephalus.
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Comparative Study
Preliminary results on the management of unruptured intracranial aneurysms with magnetic resonance angiography and computed tomographic angiography.
The goal was to assess the capability of magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) to replace catheter angiography in the evaluation of unruptured intracranial aneurysms. ⋯ Both MRA and CTA provide several advantages over digital subtraction angiography, in addition to reduced costs and avoidance of arterial injury and stroke. These include retrospective manipulation of data in a 360-degree format, visualization of the internal anatomy of arteries and aneurysms, three-dimensional depiction of anatomy, and rapid data acquisition. Preliminary data and a review of the literature suggest that MRA, when used in concert with CTA, can replace catheter angiography in the assessment of select patients harboring unruptured intracranial aneurysms. Although no firm conclusions or generalizations can be drawn from this small cohort of patients, it is hoped that this report will stimulate interest and further study at other institutions.
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Surgical management of cortical lesions adjacent to or within the eloquent cerebral cortex requires a critical risk: benefit analysis of the procedure before intervention. This study introduced a measure of surgical risk, based on preoperative magnetoencephalographic (MEG) sensory and motor mapping, and tested its value in predicting surgical morbidity. ⋯ Our results suggest that MEG mapping-derived FRPs can serve as powerful tools for use in presurgical planning and during surgery.