Neurosurgery
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Bleeding during transsphenoidal pituitary surgery can lead to a variety of operative difficulties. When the endonasal transsphenoidal approach is used, even mild intraoperative hemorrhage can lessen visibility in the confined operative field of view. This technical note describes the use of a hemostatic agent we have found of benefit in obtaining prompt hemostasis during this operation. ⋯ We detail the method in which we use FloSeal in transsphenoidal surgery and report our impression of its effectiveness. FloSeal has been demonstrated to be safe and biocompatible as compared with hemostatic agents currently in use.
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We describe a case of a posterior spinal epidural abscess that was successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy. ⋯ Surgical decompression and antibiotic therapy are the treatments of choice for patients with spinal epidural abscesses. Selected patients may be treated nonsurgically. Rarely, percutaneous drainage of the abscess has been reported to be helpful. Our case suggests that percutaneous, computed tomography-guided, needle aspiration might be a rational alternative to surgical decompression for treatment of spinal epidural abscesses.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal cord stimulation electrode design: prospective, randomized, controlled trial comparing percutaneous and laminectomy electrodes-part I: technical outcomes.
The clinical use of spinal cord stimulation for treatment of chronic intractable pain has been increasingly successful because of recent technical improvements, particularly the development of multiple-contact electrodes supported by programmable implanted pulse generators. Contemporary electrodes can be placed percutaneously in some cases and require a limited laminectomy in other cases. ⋯ We can immediately infer from these technical data that the use of an insulated array, in comparison with a percutaneous electrode, would double battery life. Extended follow-up monitoring will be required to assess the extent to which the technical advantages we observed for the insulated array might be associated with improved clinical outcomes.
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There is considerable variation in practice regarding the use of prophylactic antibiotic therapy in spinal operations. To date, individual studies have not demonstrated a significant benefit for prophylactic antibiotic therapy in spinal operations. ⋯ Prophylactic antibiotic therapy is beneficial for spinal surgery, even when expected infection rates without antibiotic treatment are low.
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Tumors of the central nervous system are now thought to be the most common form of childhood malignancies. Previous studies suggested that delays might exist between symptom onset and the diagnosis of pediatric brain tumors. In the Maritime Provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island), there are only two pediatric neurosurgical centers; therefore, the Maritime Provinces are ideal for study of the epidemiological features of pediatric brain tumors. The aim of this study was to examine the incidence rates of pediatric brain tumors in eastern Canada, as well as factors important in their diagnosis. ⋯ The incidence rates for pediatric brain tumors in the Maritime Provinces are similar to those of other reported series. The correct diagnosis of pediatric brain tumors still generally requires a number of months and frequent visits to various physicians. The majority of pediatric brainstem tumors might no longer be of a diffuse malignant nature but might represent more-focal benign lesions.