Neurosurgery
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Randomized Controlled Trial
A randomized trial of synthetic patch versus direct primary closure in carotid endarterectomy.
To define whether or not direct microscopic closure with or without the use of a vascular patch is advantageous in terms of clinical outcome and late vessel occlusion rates after microsurgical carotid endarterectomy. ⋯ No difference in vessel patency and clinical outcome has been identified after microscopic patch angioplasty and direct arteriotomy repair. The authors conclude that there is no benefit from the routine use of patch angioplasty in microscopic carotid endarterectomy.
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Periodic self-assessment is an important component of postgraduate medical education and certification. The Self-assessment in Neurological Surgery (SANS) examination has a history of usefulness for neurosurgical written and oral board examination preparation. The SANS Wired test represents a recreation of the original SANS test using an Internet-based platform. Advanced functionality and contemporary content have been added to meet the increasing requirements for demonstration of lifelong learning and self-assessment as part of the Maintenance of Certification (MOC) process. ⋯ The SANS Wired system seems to be an effective platform for neurosurgical self-assessment and is acceptable to users. The system satisfies, in part, two of the four required components of MOC, namely, periodic self-assessment and demonstration of cognitive expertise. It is endorsed by the American Board of Neurological Surgeons for MOC.
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To describe the surgical anatomy of the anterior, middle, and posterior portions of the medial temporal region and to present an anatomic-based classification of the approaches to this area. ⋯ Each approach to medial temporal lesions has technical or functional drawbacks that should be considered when selecting a surgical treatment for a given patient. Dividing the medial temporal region into smaller areas allows for a more precise analysis, not only of the expected anatomic relationships, but also of the possible choices for the safe resection of the lesion. The systematization used here also provides the basis for selection of a combination of approaches.
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Randomized Controlled Trial
Intra-arterial reteplase and intravenous abciximab in patients with acute ischemic stroke: an open-label, dose-ranging, phase I study.
New approaches are focusing on using a combination of medication that lyse fibrin and prevent aggregation of platelets to achieve higher rates of recanalization and improved clinical outcomes. ⋯ In this study, a combination of intra-arterial reteplase and intravenous abciximab was safely administered to patients with ischemic stroke presenting between 3 and 6 hours after symptom onset.
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Case Reports
Unilaterally symptomatic moyamoya disease in children: long-term follow-up of 20 patients.
In unilaterally symptomatic moyamoya disease in children, it remains controversial whether bypass surgery should be performed on the asymptomatic side along with on the symptomatic side. We aimed to verify the validity of our strategy of only performing bypass surgery on the symptomatic side. ⋯ In unilaterally symptomatic moyamoya disease, bypass surgery for the asymptomatic side can be delayed until the development of ischemic symptoms, such as frequent transient ischemic attacks.