Neurosurgery
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Biography Historical Article
A neuroforensic analysis of the wounds of President John F. Kennedy: Part 2--A study of the available evidence, eyewitness correlations, analysis, and conclusions.
A substantial body of literature exists surrounding the assassination and subsequent pathological examination of President John F. Kennedy. In the first part of this series, we provided a previously undocumented eyewitness account by a neurosurgeon of what transpired in Trauma Room 1 of Parkland Memorial Hospital on November 22, 1963. ⋯ The autopsy report, ballistics data, official reviews of the autopsy data, and Dr. Grossman's observations are correlated in an effort to provide a neuroforensic analysis of the nature of the wounds that President Kennedy sustained. The final article of the series will relate the wounds to the timing of the shots and the location of the President as his limousine traversed Dealey Plaza and will discuss the sites from which the bullets could have been fired.
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Atlantal lateral mass screws provide an alternative to C1/C2 transarticular screws and, in some cases, can obviate the need for extending a fusion to the occiput. For these reasons, C1 lateral mass screws are becoming increasingly popular. However, the critical local anatomy and unfamiliarity with this new technique can make C1 screw placement more challenging. ⋯ Significant variations in the morphology of C1 exist. However, the large size of the atlantal lateral mass makes screw placement forgiving. Preoperative computed tomographic scans and intraoperative fluoroscopy are useful in guiding proper screw placement. Close attention should be paid to preparation of the screw entry site.
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We describe an alternative surgical technique for treatment of Chiari I malformation associated with ventral compression and instability of the region. An expansive suboccipital cranioplasty and a rigid occipitocervical fixation are performed in one stage. ⋯ Simultaneous posterior decompression and occipitocervical fixation with an alternative instrumentation technique is discussed. The procedure can be performed regardless of the size of suboccipital craniectomy. Screw insertion into the diploic layer of the occipital bone has not been described previously.
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Case Reports
Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils.
The long-term durability of the endovascular occlusion of cerebral aneurysms is one of the major factors limiting the more widespread use of this technique. Long-term occlusion of wide-necked aneurysms has improved with new assistive devices that seem to improve aneurysm occlusion while protecting the parent vessel. We report the use of a new intracranial stent--the Neuroform microstent--in the treatment of patients with wide-necked cerebral aneurysms. ⋯ Intracranial stenting may overcome important technical limitations in current endovascular therapy by improving the occlusion of wide-necked aneurysms while protecting the parent vessel.