Neurosurgery
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Comparative Study
Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery.
The aim of the present study was to evaluate the overall treatment efficacy (tumor control, facial nerve function, complications) and quality of life for patients treated primarily for unilateral vestibular schwannomas of 30 mm or less, either by microsurgery or by gamma knife (GK) radiosurgery. The results for the two treatment groups are compared with each other, with main emphasis on the long-term quality of life. ⋯ Posttreatment facial nerve function, hearing, complication rates, and quality of life were all significantly in favor of GK radiosurgery.
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Juxtafacet cysts of the lumbar spine are a recognized cause of back pain, radicular symptoms, neurogenic claudication, and, less often, cauda equina compression syndrome. Hemorrhagic rupture of a juxtafacet cyst and the resulting epidural hematoma may cause chronic and/or acute cauda equina compression. ⋯ Rarely, juxtafacet cysts of the lumbar spine may rupture and hemorrhage into the epidural space causing symptomatic cauda equina compression. It is important to consider this entity when evaluating the patient with cauda equina compression. The findings of these cases give insight into the clinical presentation, operative treatment, and outcome in these patients.
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To describe the occurrence of secondary insults using a computerized monitoring data collecting system and to investigate their relationship to outcome when the neurointensive care was dedicated to avoiding secondary insults. ⋯ Overall, the secondary insults were rare, except for high CPP. The results suggest that patients with traumatic brain injury might benefit from a CPP slightly less than 60 mm Hg.
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Argatroban is a synthetic direct thrombin inhibitor. We applied argatroban locally during carotid endarterectomy to prevent local mural thrombus formation. Although local delivery of argatroban is expected to be effective for inhibition of mural clot formation, there is no report of the evaluation of its clinical effectiveness or local drug concentration in humans. ⋯ The results suggest that direct local application of argatroban during carotid endarterectomy for at least 3 minutes may deliver high local tissue levels. Argatroban may be effective for prevention of perioperative embolic cerebral complications during carotid endarterectomy.