Neurosurgery
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Comparative Study
Microsurgical anatomy and quantitative analysis of the transtemporal-transchoroidal fissure approach to the ambient cistern.
Surgical approaches to ambient cistern lesions are complex. We investigated the microanatomy of the transtemporal-transchoroidal fissure approach to the ambient cistern with emphasis on exposure of the posterior cerebral artery. ⋯ The transtemporal-transchoroidal fissure approach provides a corridor to the ambient cistern and P2-P3 junction while minimizing temporal lobe retraction and avoiding interruption of temporal lobe venous drainage. Because of widely variable vascular anatomy, access to posterior cerebral artery lesions using this approach requires preoperative imaging to identify the specific location of the P2-P3 junction.
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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.
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Review Case Reports Comparative Study
"Disc cysts" and "posterior longitudinal ligament ganglion cysts": synonymous entities? Report of three cases and literature review.
Extradural cysts intimately associated with relatively normal lumbar discs have rarely been reported. Histologically nonspecific, most have been designated posterior longitudinal ligament (PLL) or annulus fibrosus (AF) "ganglion cysts." Recently, "disc cysts" have been distinguished as a separate entity, mostly on the grounds of cyst-disc communication. ⋯ Our results and those of others suggest that all such cysts are ganglion cysts that derive from either the AF or the PLL at the disc level. Although disc cysts might be AF ganglion cysts exhibiting disc communication, their separate distinction is probably unnecessary. Cystectomy alone affords complete symptomatic remission; discectomy is usually unnecessary. Although anticipated with ganglia in general, neither spontaneous resolution nor postoperative recurrences have been witnessed. Unlike ganglia in general or juxtafacet ganglion cysts, such cysts seem to be unusually restricted to young men.
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Comparative Study
Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: a preliminary study.
Mannitol is the standard of care for patients with increased intracranial pressure (ICP), but multiple administrations of mannitol risk renal toxicity and fluid accumulation in the brain parenchyma with consequent worsening of cerebral edema. This preliminary study assessed the safety and efficacy of small-volume injections of 23.4% sodium chloride solution for the treatment of intracranial hypertension in patients with traumatic brain injury who became tolerant to mannitol. ⋯ This study suggests that 23.4% hypertonic saline is a safe and effective treatment for elevated ICP in patients after traumatic brain injury. These results warrant a rigorous evaluation of its efficacy as compared to mannitol in a prospective randomized controlled trial.
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Comparative Study
Interobserver variability in grading of brain arteriovenous malformations using the Spetzler-Martin system.
Despite its quantitative definitions, the Spetzler-Martin grading scale for brain arteriovenous malformations (AVMs) is subject to interobserver variability, particularly when observers differ in their subspecialties. Interobserver variability between neuroradiologist and neurosurgeon grading was analyzed in a large AVM series to determine its extent, causes, and clinical implications. ⋯ The Spetzler-Martin grading system can be applied reliably to most AVMs with good agreement between observers, but some unusual AVMs expose the system's imprecision and subjectivity. Interobserver variability can affect reporting of results, surgical risk assessment, and patient selection. Undergrading may encourage borderline surgical candidates to choose surgery and obtain results below their expectations.