Neurosurgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative study of propofol and midazolam effects on somatosensory evoked potentials during surgical treatment of scoliosis.
Studies of the effects on lower-limb cortical somatosensory evoked potentials (CSEP) during total intravenous anesthesia are sparse for propofol and are lacking for midazolam. This study was designed to compare the effects of propofol and midazolam on CSEP under total intravenous anesthesia during intraoperative monitoring for surgical treatment of scoliosis. ⋯ This study demonstrates the appropriate use of either propofol or midazolam in scoliosis monitoring. Preoperative small-amplitude CSEPs might favor the use of propofol anesthesia.
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Randomized Controlled Trial Clinical Trial
Angles between A1 and A2 segments of the anterior cerebral artery visualized by three-dimensional computed tomographic angiography and association of anterior communicating artery aneurysms.
The angle of arteries at bifurcations, as well as the blood flow, are factors of hemodynamic stress on the apical region, where aneurysms often develop. Using images obtained with three-dimensional computed tomographic angiography, we sought to determine the angles between the A1 and A2 segments of the anterior cerebral artery of the anterior communicating artery (ACoA) complex associated with aneurysms. These angles cannot be detected by conventional cerebral angiography. ⋯ ACoA aneurysms are associated with the smaller A1-A2 angle junction of the ACoA complex, where higher hemodynamic stress may occur in patients with normoplastic A1 segments.
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To determine the risks and survival benefit associated with implantation of an absorbable, 1,3-bis(2chloroethyl)-1-nitrosourea-impregnated polymer wafer, we prospectively studied patients with recurrent glioblastoma multiforme and compared them with a demographically matched cohort group. ⋯ 1,3-bis(2-chloroethyl)-1-Nitrosourea wafer implantation for recurrent glioblastoma was associated with a higher risk of postoperative complications, particularly those related to infection and wound healing. No clear survival benefit associated with wafer implantation was identified.
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A computer simulation based on the finite-element method was used to study the biomechanics of acute obstructive hydrocephalus and, in particular, to define why periventricular edema is most prominent in the anterior and posterior horns. ⋯ The distribution of periventricular edema in acute hydrocephalus is a result not only of increased intraventricular pressure but also of ventricular geometry.
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Schwannomas that arise from the trigeminal nerve are rare and are usually managed by surgical resection. The role of radiosurgery in the care of patients with these basal tumors remains to be defined. ⋯ As a minimally invasive alternative to microsurgery, gamma knife radiosurgery proved to be an alternative primary or adjuvant strategy that controlled tumor growth, did not cause new deficits, and often improved presenting symptoms.