Neurosurgery
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To learn how lesions with differing capacity for nerve regeneration affect the severity and duration of hyperalgesia in an animal model of neuropathic pain. ⋯ This study demonstrates that axotomy, regardless of how it is induced, produces hyperalgesia to both mechanical and cold stimuli. However, the lesion that favors regeneration is associated with earlier signs of recovery from mechanical hyperalgesia and less severe signs of cooling hyperalgesia. The data support the hypothesis that inputs from the injured afferents play an ongoing role in neuropathic pain from nerve injury. Nerve ligation induces more severe and more sustained behavioral signs of pain than nerve crush.
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To optimize the technique of implanting laminotomy plate electrodes for spinal cord stimulation and to minimize the discomfort of the patients during surgery. This operation is often performed while the patient is under local anesthesia, which is very stressful for the patient, or under general anesthesia, which precludes the use of test stimulation. An alternative approach is to perform the implantation with a spinal anesthetic and to examine whether stimulation-induced paresthesiae can still be evoked to guide the positioning of the electrode. ⋯ Implantation of laminotomy electrodes can be performed conveniently with spinal anesthesia because it minimizes discomfort for the patient and enables the use of intraoperative test stimulation to guide the positioning of the electrode. In spite of the total motor block and anesthesia, paresthesiae representing the activation of the dorsal columns can be evoked and are well perceived, and the thresholds are not abnormally high. This observation supports the notion that the subarachnoidal anesthetic agent acts predominantly on the spinal rootlets rather than on the spinal afferent pathways.
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Biography Historical Article
The assassination of President John F Kennedy: a neuroforensic analysis--part 1: a neurosurgeon's previously undocumented eyewitness account of the events of November 22, 1963.
SUBSTANTIAL LITERATURE EXISTS on the assassination and subsequent pathological examination of President John F. Kennedy. The Warren Report, the United States Government's official report on the assassination, instead of providing definitive answers on the precise cause of President Kennedy's death, sparked intense and on-going debate. ⋯ A neuroforensic analysis of the wounds, from the perspective of the neurosurgeon, would establish a reasonable hypothesis for the mechanics of the shooting. Eyewitness accounts of the events surrounding the assassination represent one critical source of data for such an analysis. This report provides a previously undocumented neurosurgeon's eyewitness account of what transpired in Trauma Room 1 of Parkland Memorial Hospital on November 22, 1963.
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A patient-oriented classification scheme for facial pains commonly encountered in neurosurgical practice is proposed. ⋯ This diagnostic classification would allow more rigorous and objective natural history and outcome studies of facial pain in the future.
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The optimal surgical treatment for symptomatic temporal arachnoid cysts is controversial. Therapeutic options include cyst shunting, endoscopic fenestration, and craniotomy for fenestration. We reviewed the results for patients who were treated primarily with craniotomy and fenestration at our institution, to provide a baseline for comparisons of the efficacies of other treatment modalities. ⋯ A microsurgical keyhole approach to arachnoid cyst fenestration is a safe effective method for treating middle fossa cysts. This procedure can be performed with minimal morbidity via a minicraniotomy. Compared with an endoscopic approach, better control of hemostasis can be obtained, because of the ability to use bipolar forceps and other standard instruments. The operative time and length of hospital stay were not excessively increased.