Neurosurgery
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Treatment of patients who fail epilepsy surgery is problematic. Selected patients may be candidates for further surgery, potentially leading to a significant decrease in the frequency and severity of seizures. We present our long-term outcome series of highly investigated patients who failed resective epilepsy surgery and subsequently underwent reoperative resective procedures. ⋯ Reoperation should be considered in selected patients failing epilepsy resective surgery because approximately 50% of patients may have benefit. Patients with cortical dysplasia and mesial temporal sclerosis are less likely to improve after reoperation.
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Case Reports
Ruptured proximal lenticulostriate artery fusiform aneurysm presenting with subarachnoid hemorrhage: case report.
Lenticulostriate artery aneurysms are rare. When present, distal locations in and around the basal ganglia are more common and often present with intraparenchymal hemorrhage when ruptured. We present a very rare case of a ruptured proximal lenticulostriate fusiform aneurysm presenting with subarachnoid hemorrhage. ⋯ This is the first report of a ruptured proximal lenticulostriate artery fusiform aneurysm, which presented as subarachnoid hemorrhage in a healthy patient without an underlying vascular disease.
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Biography Historical Article
Wilder Penfield, Pío del Río-Hortega, and the discovery of oligodendroglia.
To describe the contribution of Wilder Penfield to the early characterization of glial cells in collaboration with Pío Del Río-Hortega and Santiago Ramón y Cajal during his study in La Residencia des Estudiantes, Laboratorio de Histopatología in Madrid in 1924. ⋯ Today, Wilder Penfield is much better known for his seminal explorations of the cortical basis of higher function, his contributions to epilepsy surgery, and as the founder of the Montreal Neurological Institute than for his original work with Sherrington in England or Río-Hortega and Cajal in Spain. While working with Río-Hortega, his report on oligodendroglia was critical to advancing the characterization of this important class of glial cells.
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Comparative Study
Predictors of neurosurgical career choice among residents and residency applicants.
Medical students applying for neurosurgery residency positions almost all aspire to become academic neurosurgeons. However, most graduates of neurosurgery residency programs ultimately follow careers in private practice. We hypothesized that there might be factors in a resident's application, interviews, or performance during residency that might predict this change in career orientation. ⋯ Honest discussion between residents and faculty about the choice between academic and private practice careers may be as informative as the three identified predictors of residents' career orientation. Academic faculty members can encourage communication by discouraging the perception that a resident's education might be compromised if he or she expresses interest in private practice rather than academic neurosurgery. Open communication on this issue might enable faculty mentors to actively advise residents in their career decisions and improve the residents' educational environment.
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Meta Analysis Comparative Study
Efficacy of prophylactic antibiotics against meningitis after craniotomy: a meta-analysis.
Although prophylactic antibiotics have been shown by randomized clinical trials (RCTs) to help prevent deep infection after craniotomies, recent reports have suggested that antibiotics are not effective in preventing postcraniotomy meningitis. ⋯ Prophylactic antibiotics administered before craniotomy reduce rates of postoperative meningitis by approximately one-half, a statistically and clinically significant benefit.