Neurosurgery
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Comparative Study Clinical Trial
Subpectoral implantation of the vagus nerve stimulator.
To report the technique of subpectoral (SP) implantation of the vagus nerve stimulator (VNS) generator. ⋯ The SP implantation technique provides an attractive alternative to SQ VNS implantation. With increased soft tissue coverage, we provide improved cosmesis, increased wound durability to tampering and trauma, and a comparable infection rate with the SQ group.
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Comparative Study Clinical Trial
Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine-year experience.
To describe surgical endoscopic experience in the repair of cerebrospinal fluid leaks treated by transnasal approaches. ⋯ The target of endoscopic endonasal technique in the repair of cerebrospinal fluid leaks is to ensure a stable duraplasty with the least invasive approach avoiding craniotomy. A correct diagnosis surely allows the choice of the best treatment, surgical approach, graft, and technique. Our multidisciplinary approach to this pathology during these years has been essential to gain our challenging results.
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Embolization is an important therapeutic modality in the multidisciplinary management of arteriovenous malformations (AVM); however, prior series have reported a wide variability in overall complication rates caused by embolization (10-50% neurological deficit, 1-4% mortality). In this study, we reviewed our experience with AVM embolization and analyzed factors that might predict complications and clinical outcomes after AVM embolization. ⋯ In a single-center, retrospective, nonrandomized study, 90.5% of patients had excellent or good outcomes after AVM embolization, with a complication rate lower than previously reported. Spetzler-Martin grade III to V and periprocedural hemorrhage were the most important predictive factors in determining outcome after embolization.
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To evaluate possible applications of microsurgical extirpation to arteriovenous malformations (AVMs) involving the brainstem. ⋯ Surgical resection can be applied with considerable, but acceptable, morbidity and mortality in some groups of brainstem AVMs with hemorrhagic presentation, particularly dorsal midbrain and cerebellopontine angle types, in which most parts of the nidus located sub- or extrapially.
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Comparative Study
Acute traumatic intraparenchymal hemorrhage: risk factors for progression in the early post-injury period.
To characterize the natural course of traumatic intraparenchymal contusions and hematomas (IPHs) and to identify risk factors for IPH progression in the acute post-injury period. ⋯ A large proportion of IPHs progress in the acute post-injury period. IPHs associated with subarachnoid hemorrhage, a subdural hematoma, or large initial size should be monitored carefully for progression with repeat head CT imaging. Effacement of cisterns on the initial head CT scan was strongly predictive of failure of nonoperative management, thereby leading to surgical evacuation. These findings should be important factors in the understanding and management of IPH.