Neurosurgery
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Increasing costs and concerns about blood supply safety have led to a reevaluation of blood transfusion practices. This study was undertaken to examine blood use during aneurysm surgery. ⋯ Blood transfusion can be expected in one in five patients undergoing aneurysm surgery. Reducing intraoperative rupture may reduce the need for blood products.
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Biography Historical Article
The contributions of Otfrid Foerster (1873-1941) to neurology and neurosurgery.
BEST REMEMBERED FOR his description of the dermatomes in man, Otfrid Foerster was also an adept neurosurgeon and an innovative experimental neurophysiologist. As a neurologist, his contributions included conceptualizing rhizotomy as a cure for spasticity, anterolateral cordotomy for pain, the hyperventilation test in epilepsy, Foerster's syndrome, and the first electrocorticogram of a brain tumor. As a neurosurgeon, Foerster was able to excise intraventricular, hypophyseal, and quadrigeminal lesions and to perform epilepsy surgery under primitive conditions without clips, diathermy, or suction. ⋯ Students who flocked to learn from his encyclopedic knowledge and skill were privy to Foerster's legendary hospitality and charm. A man of delicate constitution, he was single-minded in his quest to unravel the mysteries of the nervous system. The inscription "Patriae scientiae inserviendo" or "In the service of science and Fatherland" was chosen by Foerster for his Institute of Neurology and is a fitting memorial to this neurosurgical giant.
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Distal ventriculoperitoneal shunt failure has been associated with absorption failure secondary to previous peritonitis. This assumption has caused surgeons to seek alternate sites for distal catheter placement. We propose that the absorptive potential of the peritoneal cavity should be assessed before that site is discounted for catheter placement. ⋯ The peritoneal cavity remains the site of choice for distal shunt catheter placement. If failure of peritoneal cerebrospinal fluid absorption is suspected as a cause of shunt failure, then peritoneography with water-soluble contrast material may be safely used to demonstrate the adequacy of fluid absorption before a secondary site is chosen.
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The aim of this article was to analyze the technical and methodological issues resulting from the use of functional magnetic resonance image (fMRI) data in a frameless stereotactic device for brain tumor or pain surgery (chronic motor cortex stimulation). ⋯ In brain tumor surgery, fMRI data are helpful in surgical planning and guiding intraoperative brain mapping. The registration of fMRI data in anatomic slices or in the frameless stereotactic neuronavigational device, however, remained a potential source of functional mislocalization. Electrode placement for chronic motor cortex stimulation is a good indication to use fMRI data registered in a neuronavigational system and could replace somatosensory evoked potentials in detection of the central sulcus.
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To assess the safety, feasibility, and clinical outcome of percutaneous transpedicular polymethylmethacrylate vertebroplasty (PTPV) for the treatment of spinal compression fractures causing refractory pain. ⋯ PTPV provided significant relief in a high percentage of patients with refractory pain. PTPV is a safe and feasible treatment for patients with spinal compression fractures.