Neurosurgery
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Comparative Study
Biomechanical comparison of two stabilization techniques of the atlantoaxial joints: transarticular screw fixation versus screw and rod fixation.
To compare the biomechanical stability imparted to the C1 and C2 vertebrae by either transarticular screw fixation (TSF) or screw and rod fixation (SRF) techniques in a cadaver model. ⋯ In general, a surgeon should undertake a bilateral fixation to achieve sufficient stability across the atlantoaxial complex, and either technique will provide satisfactory results, although the SRF technique may be better in the flexion and extension modes. One should use the SRF procedure while trying to achieve stability with a unilateral system.
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Decompressive hemicraniectomy has been proposed as a potential treatment strategy in patients with poor-grade aneurysmal subarachnoid hemorrhage presenting with focal intracerebral hemorrhage causing significant mass effect. Although hemicraniectomy improves overall survival rates, the long-term quality of life (QoL) for survivors in this patient population has not been reported. ⋯ Decompressive hemicraniectomy prolongs short-term survival in patients with poor-grade aneurysmal subarachnoid hemorrhage with associated intracerebral hemorrhage; however, this trend is not statistically significant, and the overall QoL experienced by survivors is poor. Decompressive hemicraniectomy may be indicated if performed early in a select subset of patients. On the basis of our preliminary data, large prospective studies to investigate this issue further may not be warranted.
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We have previously shown that constitutively active epidermal growth factor receptor signaling enhances the survival and motility of engrafted neural stem cells (NSCs) when transplanted into normal adult brain. In the present study, using the C17.2 NSC line stably transfected with the constitutively active epidermal growth factor receptor vIII, we sought to evaluate the phenotype of NSCs after engraftment into the milieu of traumatic head injury. ⋯ Our results suggest that the environment associated with acute experimental TBI can significantly modulate the phenotype and migratory patterns of the engrafted NSC. These findings have particularly important implications for transplantation of NSCs into the traumatically injured nervous system.
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Case Reports Comparative Study
Surgical exposure of the sciatic nerve in the gluteal region: anatomic and historical comparison of two approaches.
To increase awareness among neurosurgeons of alternative surgical approaches to lesions of the sciatic nerve in the gluteal region. ⋯ At the present time, the majority of peripheral nerve surgeons use an infragluteal approach to the proximal sciatic nerve. However, for select patients with well-defined and localized lesions, the transgluteal approach may provide sufficient nerve exposure with lowered operative complexity and postoperative morbidity.
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More survivors of traumatic atlanto-occipital dislocation (AOD) in adults have recently been reported. Surgical management options are therefore of increasing interest. We present a new technique of posterior C0-C1-C2 fixation. ⋯ The surgical technique described was thought to be safe to perform and resulted in immediate stability without external immobilization. Solid fusion was achieved 6 months after surgery.