Neurosurgery
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To introduce the possibility of volume-rendered helical computed tomographic (CT) angiographic data sets by use of Medtronic StealthStation Treon surgical navigation technology (Medtronic Surgical Navigation Technologies, Louisville, CO) and to evaluate the clinical usefulness of the method in planning and performing surgical treatment of intracranial aneurysms. ⋯ Reports in the literature indicate that information gathered by CT angiography with volume rendering shows a significant impact on aneurysm management. The StealthStation system upgraded with the adequate algorithm seems to provide a time- and cost-effective method of performing automated 3-D volume rendering of CT angiography and provides an interesting alternative to the available investigation modalities in case of emergency.
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During the past decade, endovascular obliteration of intracranial aneurysms and new treatments for vasospasm and cerebral ischemia have been introduced. To analyze the effectiveness of these new strategies, we evaluated changes in morbidity and mortality rates in patients at least 18 years of age who were hospitalized for ruptured and unruptured intracranial aneurysms during the past 16 years. ⋯ The mortality rate for unruptured intracranial aneurysms demonstrates a significant trend of reduction during the past 16 years. The mortality rate for SAH demonstrates limited change during the same period; it is presumed that this is attributable to the multitude of factors that influence outcome.
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Intraspinal solitary fibrous tumors, which are rare mesenchymal tumors, have previously been reported as case reports. We review our experience and, to our knowledge, the first small institutional series with respect to clinical presentation, diagnosis, surgical management, pathohistological analysis, progression-free survival, and long-term outcome. ⋯ Patients with solitary fibrous tumors have a long survival. These tumors have an indolent course, and radiotherapy or chemotherapy seems to be unnecessary.
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How to manage the distal anterior cerebral artery (ACA) circulation in the treatment of a giant anterior communicating artery aneurysm or a giant azygous A2 aneurysm is still controversial. ⋯ In cases in which direct clipping to preserve distal ACA flow is quite difficult, the bilateral ACA revascularization described here should be considered as another possibility.
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Historical Article
Hippocrates: a pioneer in the treatment of head injuries.
Hippocrates' treatise On Wounds in the Head represents an excellent source of information regarding the extent of experience with head injuries in classical antiquity. On the basis of clinical observation, the great physician gives an accurate description of the external appearance and consistency of the cranium. ⋯ Trepanation, a neurosurgical procedure still in practice today, is presented in detail. As a whole, the treatise, the first written work in medical history dealing exclusively with cranial trauma, reveals that Hippocrates was a pioneer in treating head injuries.