Neurosurgery
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Comparative Study
Comparative safety and efficacy of topical hemostatic agents in a rat neurosurgical model.
Adequate hemostasis is extremely important in neurosurgery, commonly requiring the use of topical hemostatic agents. Apart from variable efficacy, the residual presence of these agents may cause foreign body reaction, infection, and delayed bone growth. This study compares the safety and efficacy of commonly used agents with a newly approved agent, Arista (microporous polysaccharide hemospheres; Medafor, Inc., Minneapolis, MN). ⋯ Each of these hemostatic agents was effective in controlling bleeding in the majority of standardized neurosurgical lesions. Arista degrades more rapidly than Surgicel, Avitene, and FloSeal and does not result in any foreign body reaction.
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Despite new endovascular techniques and technological advances in microsurgery, the treatment of giant intracranial aneurysms is still a daunting neurosurgical task. Many of these aneurysms have a large, calcified neck, directly involve parent and collateral branches, and are partly thrombosed. In this retrospective review, we focused our analysis on the indications for high-flow, extracranial-intracranial (EC-IC) bypass surgery using a saphenous vein graft. ⋯ The "gold standard" for the treatment of giant aneurysms remains surgical clipping. When direct surgical clipping or endovascular repair is contraindicated, the high-flow EC-IC bypass is a viable surgical option.
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To examine a case series of reoperations for deep brain stimulation (DBS) leads in which clinical scenarios revealed suboptimal outcome from a previous operation. Suboptimally placed DBS leads are one potential reason for unsatisfactory results after surgery for Parkinson's disease (PD), essential tremor (ET), or dystonia. In a previous study of patients who experienced suboptimal results, 19 of 41 patients had misplaced leads. Similarly, another report commented that lead placement beyond a 2- to 3-mm window resulted in inadequate clinical benefit, and, in 1 patient, revision improved outcome. The goal of the current study was to perform an unblinded retrospective chart review of DBS patients with unsatisfactory outcomes who presented for reoperation. ⋯ There are many potential causes of suboptimal benefit after DBS. Timely identification of suboptimal lead placements followed by reoperation and repositioning/replacement in a subset of patients may improve outcomes.
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The aim of this study was to demonstrate the usefulness of a mobile, intraoperative 0.15-T magnetic resonance imaging (MRI) scanner in glioma surgery. ⋯ The use of the PoleStar N-20 intraoperative ultra low-field MRI scanner helps to evaluate the extent of resection in glioma surgery. Further tumor resection after intraoperative scanning leads to an increased rate of complete tumor resection, especially in patients with contrast-enhancing tumors. However, in noncontrast- enhancing tumors, the intraoperative visualization of a complete resection seems less specific, when compared with postoperative 1.5-T MRI.