Neurosurgery
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To describe a new endoscope shaft developed for suction-aspiration during endoscopic transsphenoidal pituitary surgery. ⋯ The new shaft improves the ergonomics of endoscopic transsphenoidal pituitary surgery in cases in which the endoscope is handheld.
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Arteriovenous malformations are a heterogeneous group of intra-axial central nervous system vascular lesions consisting of tangles of abnormal arteriovenous connections without intervening capillary beds. The heterogeneity of arteriovenous malformations is described by the Spetzler-Martin grading scale, a scale that also forms the basis for clinical decision making. The microsurgical treatment of appropriately selected supratentorial arteriovenous malformations is based on the tenets of circumferential isolation and transection of arterial feeders, preservation of vessels en passant and surrounding functional neural tissue, and skeletonization and transection of venous drainage.
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Randomized Controlled Trial Comparative Study Clinical Trial
D-dimer predicts outcome after aneurysmal subarachnoid hemorrhage: no effect of thromboprophylaxis on coagulation activity.
Approximately one-third of all patients with acute nontraumatic subarachnoid hemorrhage (SAH) experience complications owing to delayed ischemic deficit. We reported recently that enoxaparin 40 mg once daily for 10 days seems safe and demonstrates thromboprophylactic efficacy, but it failed to improve outcome in a randomized SAH trial. In the present study, we assessed hemostatic variables associated with clinical status and outcome of SAH. We also monitored the effect of enoxaparin on activation of coagulation and fibrinolysis after closure of the ruptured aneurysm. ⋯ D-dimer offers a useful laboratory tool for assessing early and late clinical severity of SAH. A thromboprophylactic dose of enoxaparin inhibited PAI-1 activity but failed to down-regulate coagulation activity and D-dimer. These findings are compatible with the lack of efficacy of enoxaparin in reducing ischemic deficit after SAH.
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The clinical and radiographic presentations of optic nerve gliomas and optic neuritis are for the most part distinct and their diagnoses straightforward. We present two cases illustrating the occasional difficulty one can encounter in distinguishing neoplastic from inflammatory optic neuropathies. ⋯ Differentiating between optic nerve neoplasm and inflammation may be difficult. On occasion, the classic clinical finding of pain with eye movement and the radiographic finding of enlargement and enhancement of the optic nerve may be misleading. Open biopsy of the optic nerve is indicated only after a completely negative metabolic, infectious, and inflammatory workup; interval increase of the optic nerve on magnetic resonance imaging; and failure of the patient to recover vision.
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Comparative Study Clinical Trial
Management and outcomes of 42 surgical suprascapular nerve injuries and entrapments.
Retrospective chart reviews of 42 patients with surgical suprascapular nerve (SSN) injury/entrapment were performed. Presenting symptoms, findings, operative approach, and results are documented. ⋯ Although SSN injury/entrapment is rare, 42 patients are presented who responded well to SSN release. Supraspinatus muscle improvement was as good as or better than that achieved in the infraspinatus.