Neurosurgery
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What is known about the cerebral aqueduct is derived mainly from the legacy of classic histology and from the most recent advanced neuroimaging technologies. In fact, although this important structure is frequently glimpsed by neurosurgeons, only limited anatomic contributions have been added by microsurgery to its direct in vivo description. A review of our surgical experience in navigating the fourth ventricle prompted us to revisit the classical anatomic descriptions of the aqueduct and compare them using the novel perspective of neuroendoscopy. ⋯ Neuroendoscopy provides a novel perspective into the inner aqueductal wall and supplies an incomparable view of the intracanalicular anatomic structures.
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Comparative Study
Ventriculoperitoneal shunt complications in California: 1990 to 2000.
Risk factors for ventriculoperitoneal (VP) shunt complications have not been assessed with population cohort data since the advent of modern surgical techniques. We examined demographic factors and VP shunt complications in a population-based retrospective cohort study of all nonfederal California hospital admissions between 1990 and 2000. ⋯ VP shunt complications are common, especially in children. Further study is needed to explain the associations between demographic factors and elevated shunt complication rates.
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Comparative Study Clinical Trial
The kinematics of anterior cervical discectomy and fusion versus artificial cervical disc: a pilot study.
Anterior cervical discectomy and fusion (ACDF) for the management of cervical spondylosis may contribute to further degenerative changes at adjacent levels secondary to abnormal spinal motion. Insertion of a Bryan Cervical Disc (AD) (Medtronic Sofamor Danek, Memphis, TN) may prevent this accelerated degeneration. This retrospective study compares the in vivo x-ray cervical spine kinematics in patients with ACDF and AD. ⋯ Patients with AD and those with ACDF demonstrated similar in vivo adjacent level kinematics within the first 24 months after anterior cervical decompression.
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Perforating arteries are commonly involved during the surgical dissection and clipping of intracranial aneurysms. Occlusion of perforating arteries is responsible for ischemic infarction and poor outcome. The goal of this study is to describe the usefulness of near-infrared indocyanine green videoangiography (ICGA) for the intraoperative assessment of blood flow in perforating arteries that are visible in the surgical field during clipping of intracranial aneurysms. In addition, we analyzed the incidence of perforating vessels involved during the aneurysm surgery and the incidence of ischemic infarct caused by compromised small arteries. ⋯ The involvement of perforating arteries during clip application for aneurysm occlusion is a usual finding. Intraoperative ICGA may provide visual information with regard to the patency of these small vessels.
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Comparative Study
Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications.
An increasing number of intracranial dural arteriovenous fistulae (DAVFs) are amenable to endovascular treatment. However, a subset of patients with high-risk lesions requires surgical intervention for complete obliteration. We reviewed our experience with the surgical management of high-risk intracranial DAVFs and offer recommendations to minimize complications based on fistula location and type. ⋯ Despite fulminant presenting symptoms, high-risk intracranial DAVFs can be successfully managed with good outcomes. When anatomic features prevent endovascular access, or embolization fails to obliterate the lesion, urgent surgical treatment is indicated. Patients with residual filling of the DAVF should be considered for adjuvant therapy, including further embolization or radiosurgery.