Neurosurgery
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At many centers, patients undergo both computed tomographic angiography (CTA) and digital subtraction angiography (DSA). This practice negates most of the advantages of CTA, and it renders the risks and disadvantages of the two techniques additive. Previous reports in the literature have assessed the sensitivity and specificity of CTA compared with DSA; however, these investigations have not analyzed the clinical implications of a protocol that replaces DSA with CTA as the only diagnostic and pretreatment planning study for patients with cerebral aneurysms. ⋯ We have demonstrated promising results with a prospective protocol of CTA in place of DSA as the only diagnostic and pretreatment planning study for patients with ruptured and unruptured cerebral aneurysms. It seems safe and effective to make decisions regarding treatment on the basis of CTA, without performing DSA, in the majority of patients with ruptured and unruptured cerebral aneurysms.
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Clinical Trial
Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction?
Preliminary studies have suggested that prolonged retraction of the paraspinal muscle during spinal surgery may produce ischemic damage. We report the continuous measurement of intramuscular pressure (IMP) during decompressive lumbar laminectomy and its relationship to subsequent back pain and disability. ⋯ The McCulloch retractor generates a higher IMP than the Norfolk and Norwich retractor. However, postoperative improvement in VAS, ODI, and SF-36 scores in these patients was associated with a shorter duration of muscle retraction and not the degree of IMP or IPP generated. In this respect, periodic relaxation of the paraspinal muscle retractors during surgery to allow muscle perfusion may help to reduce postoperative back pain and disability.
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We hypothesized that coexisting extranidal arterial aneurysms (EAs) would be associated with an increased risk of incident intracranial hemorrhage (ICH) from brain arteriovenous malformation (BAVM) rupture. ⋯ Clinical presentation with ICH was associated with EA aneurysms, but the association was due to aneurysmal rather than BAVM rupture, suggesting that EAs and the BAVM ICH risks may be considered as separate entities in future studies.
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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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To describe the exposure obtained through six approaches to the perimesencephalic cisterns with an emphasis on exposure of the posterior cerebral artery and its branches. ⋯ Surgical approaches to lesions of the perimesencephalic cisterns must be tailored to the site of the pathological findings. The most challenging area to expose is the upper half of the ambient cistern, particularly the P2p segment of the posterior cerebral artery.