Neurosurgery
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Complex tumors OF the glomus jugulare present a surgical challenge because of their difficult location, extreme vascularity, and involvement with multiple cranial nerves. Modern microneurosurgical and cranial base techniques have enabled safe total removal of these complicated tumors. We describe a one-stage transjugular posterior infratemporal fossa approach for radical resection of glomus jugulare tumors located around the jugular foramen, the lower clivus, and the high cervical region from an anterolateral direction. ⋯ Total exposure of the jugular foramen can be achieved, and multidirectional approaches can be performed, including infralabyrinthine/suprajugular, retrosigmoid/transcondylar/infrajugular, and transjugular exposures. Exposure of the vertical C7 segment of the infratemporal internal carotid artery and the lower clivus can be performed without permanent rerouting of the facial nerve. The details of this approach are described and illustrated in a stepwise fashion, and the microsurgical anatomy is reviewed.
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To evaluate incidence and risk factors of postoperative meningitis, with special emphasis on antibiotic prophylaxis, in a series of 6243 consecutive craniotomies. ⋯ Perioperative antibiotic prophylaxis, although clearly effective for the prevention of incision infections, does not prevent meningitis and tends to select prophylaxis resistant microorganisms.
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Stroke is a leading cause of morbidity and mortality in the United States. Recent animal studies have implicated the complement system in cerebral ischemia/reperfusion injury and suggest that complement inhibition may improve stroke outcomes. To assess the applicability of these findings to humans, we evaluated the characteristics and time course of human complement activation after stroke. ⋯ C3a is acutely elevated after human ischemic stroke, C5a shows delayed elevations 7 to 14 days after cerebral ischemia, and sC5b-9 is acutely depressed after stroke. Together, these data confirm complement activation after stroke and suggest that this activation is a heterogeneous process, with varying responses for different components.
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To stratify the risk of embolization during the treatment of cerebral arteriovenous malformations (AVMs) by grade and to assess its impact on the overall treatment risk. ⋯ Endovascular treatment carries a procedural risk related to AVM grade and number of branches treated. This risk should be weighed carefully in the context of overall treatment morbidity and mortality.