Neurosurgery
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Case Reports
Staged deep brain stimulation for refractory craniofacial dystonia with blepharospasm: case report and physiology.
We report the intraoperative results, subsequent course, and 1-year follow-up evaluation of a patient with medication-refractory craniofacial dystonia for whom we planned bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) implantation but delayed the left GPi DBS implantation because of robust intraoperative effects of right GPi DBS. ⋯ Although DBS for primary generalized dystonia is commonly performed by simultaneously implanting bilateral GPi electrodes, it may be reasonable in cases of refractory blepharospasm and/or craniofacial dystonia to use a staged procedure for implantation in selected patients. Additionally, the physiology, especially that encountered in the striatum, may help to elucidate the pathophysiological basis for refractory blepharospasm and Meige's syndrome. More cases will be needed to determine the significance of the results reported in this article.
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The new Accreditation Council for Graduate Medical Education (ACGME) requirements regarding resident work hours have been implemented since July 2003. Neurological surgery training programs have been especially affected because of the limited number of residency positions and the residents' long duty hours. The perceptions of program directors and residents may provide important insight into the evolution of new guidelines for improvement of resident training. ⋯ On the basis of their early experience, the majority of the residents and program directors think that the ACGME duty hour guidelines have had an adverse effect on continuity of patient care and resident training. The effects of these guidelines on neurosurgery programs should be carefully monitored, because more sophisticated solutions may be needed to address house staff fatigue. Strategies to enhance the educational content of the residents' work hours and to preserve continuity of patient care are necessary.
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Review Case Reports Comparative Study
Treatment of spinal cord perimedullary arteriovenous fistula: embolization versus surgery.
To provide the optimal treatment strategy for perimedullary arteriovenous fistula (PMAVF). ⋯ Good results were achieved with surgery for Types IVa and IVb PMAVF located at the level of the conus medullaris. For Type IVc PMAVF, a fistula located on the ventral side of the spinal cord or above the conus medullaris, endovascular treatment might be considered. Because of rapidly evolving endovascular techniques, however, further studies are warranted.
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Randomized Controlled Trial Multicenter Study Comparative Study
Local and sustained delivery of 5-fluorouracil from biodegradable microspheres for the radiosensitization of malignant glioma: a randomized phase II trial.
This study was a randomized, multicenter Phase II trial comparing the effect of perioperative implantation of 5-fluorouracil-releasing microspheres followed by early radiotherapy (Arm A) and early radiotherapy alone (Arm B) in patients with gross total resection of high-grade glioma. ⋯ It may be hypothesized that the implantation of 5-fluorouracil-loaded microspheres in the wall of the cavity resection did increase the overall survival, but the present study was not designed and sufficiently powered to demonstrate this.
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Review Case Reports
Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome treated with microvascular decompression of the trigeminal nerve: case report.
Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome is a very rare disorder characterized by short-lasting neuralgiform unilateral pain affecting the orbital-periorbital area and associated with autonomic phenomena consisting mainly of conjunctival injection, tearing, and rhinorrhea. Treatment of this condition is difficult; many drugs and surgical procedures have been tried with variable results. In the literature, two cases have been described with short-term response to microvascular decompression of the trigeminal root. We present the case of a patient with short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome who remains asymptomatic 2 years after microvascular decompression. ⋯ Microvascular decompression could be an alternative therapeutic approach to this rare syndrome.