Neurosurgery
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Comparative Study
Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus.
The response to shunt surgery for idiopathic normal-pressure hydrocephalus (INPH) is variable because INPH is difficult to distinguish from other conditions causing the same symptoms. To date, no clinical picture or diagnostic test can distinguish INPH or predict response to cerebrospinal fluid (CSF) shunt surgery. We reviewed our 10-year experience with INPH to characterize long-term outcome and to identify independent predictors of outcome after shunt surgery. ⋯ INPH can be diagnosed accurately with CSF pressure monitoring and CSF drainage via a spinal catheter. CSF shunting is safe and effective for INPH with a long-term shunt response rate of 75%. Independent predictors of improvement are the presence of gait impairment as the dominant symptom and shorter duration of symptoms.
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Case Reports Comparative Study
Transcallosal transchoroidal approach to tumors of the third ventricle.
Although the literature is rich with descriptions of the approach to the third ventricle, surgeons remain cautiously reserved. In this report, we demonstrate that the transcallosal approach can be easily performed provided that preoperative planning is adequate. Familiarity with the course of major cortical and deep draining veins grants the surgeon a wide exposure of the posterior third ventricle. We discuss the indications, surgical technique, and pitfalls to this approach while providing an accompanying video mirroring our discussion.
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Medical treatment of Tourette syndrome is often ineffective or is accompanied by debilitating side effects, therefore prompting the need to evaluate surgical therapies. ⋯ Our findings suggest that stimulation of the anterior internal capsule may be a safe and effective procedure for the treatment of Tourette syndrome.
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Comparative Study
Techniques for aspirating bone marrow for use in spinal surgery.
The osteogenicity of bone marrow has been well documented in the literature. The use of bone marrow as a source of osteoprogenitor cells for spinal fusion surgery is increasing. Improper aspiration technique can lead to dilution of bone marrow and a subsequent reduction in osteoprogenitor cells. Therefore, correct aspiration technique is imperative to the successful use of bone marrow with various grafting combinations. ⋯ Clinical studies currently under way will answer the question of bone marrow efficacy in spinal fusion surgery.
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Review Comparative Study Clinical Trial
Olfactory groove meningiomas from neurosurgical and ear, nose, and throat perspectives: approaches, techniques, and outcomes.
To review the surgical approaches, techniques, outcomes, and recurrence rates in a series of 80 olfactory groove meningioma (OGM) patients operated on between 1990 and 2003. ⋯ A variety of surgical approaches are used for OGM resection. An approach tailored to the tumor's size, location, and extension, combined with modern microsurgical cranial base techniques, allows full OGM removal with minimal permanent morbidity, excellent neurological outcome, and very low recurrence rates.