Neurosurgery
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We note an additional pathological condition associated with lumbar spinal stenosis that may be responsible for significant postoperative pain. Recognizing that nerve roots are stretched around hypertrophic pedicles in some cases of spinal stenosis, we have altered our surgical management of these cases to address what may be a previously unrecognized but significant anatomic pathological finding. ⋯ Anatomic evidence obtained through intraoperative examination and preoperative imaging techniques indicates that partial pediculectomy may play a role in the treatment of some cases of lumbar stenosis.
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There are few modern data on the complications of surgery for epilepsy from the neurosurgeon's point of view. A survey of complications observed in a large current epilepsy surgery series is presented to facilitate the assessment of a risk:benefit ratio, which must be known when planning for epilepsy surgery and counseling patients. ⋯ Our data indicate that epilepsy surgery can be performed with an acceptable rate of resultant morbidity. The indications for epilepsy surgery, the learning curve determined, and the results from other series are discussed in the light of these figures.
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To examine the incidences of hypertension, hypotension, and bradycardia after carotid endarterectomy (CEA) and to identify any hemodynamic variables predictive of postoperative stroke, death, or cardiac complications. ⋯ Hemodynamic instability was commonly observed after CEA, but only postoperative hypertension was associated with stroke or death and, possibly, with cardiac complications. Patients undergoing CEA, especially those at risk for postoperative hypertension, may be monitored best in settings suited to the expeditious management of neurological and cardiovascular emergencies.
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Biography Historical Article
Yi-Cheng Zhao: a founder of neurosurgery in China.
Yi-Cheng Zhao was trained in neurosurgery at the Montreal Neurological Institute by Wilder Penfield in 1938. This article presents Zhao's great contributions to the development of neurosurgery in China. He set up the first independent neurosurgical departments in Tianjin (1952) and in Beijing (1954). ⋯ It plays an important role in the development of Chinese neurosurgery. Zhao devoted nearly 40 years to neurosurgery and died in 1974. The chinese Neurosurgical Association has honored Zhao as "a founder of neurosurgery in China."
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Cerebrovascular vasomotor reactivity reflects changes in smooth muscle tone in the arterial wall in response to changes in transmural pressure or the concentration of carbon dioxide in blood. We investigated whether slow waves in arterial blood pressure (ABP) and intracranial pressure (ICP) may be used to derive an index that reflects the reactivity of vessels to changes in ABP. ⋯ Computer analysis of slow waves in ABP and ICP is able to provide a continuous index of cerebrovascular reactivity to changes in arterial pressure, which is of prognostic significance.