Neurosurgery
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The response to shunt surgery for idiopathic normal-pressure hydrocephalus (INPH) is variable because INPH is difficult to distinguish from other conditions causing the same symptoms. To date, no clinical picture or diagnostic test can distinguish INPH or predict response to cerebrospinal fluid (CSF) shunt surgery. We reviewed our 10-year experience with INPH to characterize long-term outcome and to identify independent predictors of outcome after shunt surgery. ⋯ INPH can be diagnosed accurately with CSF pressure monitoring and CSF drainage via a spinal catheter. CSF shunting is safe and effective for INPH with a long-term shunt response rate of 75%. Independent predictors of improvement are the presence of gait impairment as the dominant symptom and shorter duration of symptoms.
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Infection involving the cerebrum is a true neurosurgical emergency that requires rapid diagnosis and appropriate surgical and medical intervention to achieve good clinical outcome. ⋯ Combining advanced imaging and surgical techniques in the form of intraoperative magnetic resonance image-guided neurosurgery may further enhance clinical outcomes in these once uniformly fatal diseases.
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We sought to assess the value of adjusting shunt valve opening pressure, complications, and outcomes with the use of an adjustable shunt valve in the treatment of patients with normal-pressure hydrocephalus (NPH). ⋯ Noninvasive, particularly consecutive, minor or single larger adjustments to the valve opening pressure can further improve outcome in patients with NPH who undergo shunting.
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Comparative Study
Long-term seizures and quality of life after epilepsy surgery compared with matched controls.
We compared long-term seizure outcome and health-related quality of life (HRQoL) of patients who underwent epilepsy surgery and matched medically treated nonsurgical controls with intractable epilepsy. ⋯ After an average of more than 15 years of follow-up, epilepsy surgery patients had fewer seizures, used less antiepileptic medication, and had better HRQoL in several dimensions of the Quality of Life in Epilepsy Inventory 89 instrument than matched medically treated controls with refractory epilepsy, although possibly at a slight disadvantage in the language dimension among those with 7 years of follow-up or less.
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Balloon compression of the rootlets behind the trigeminal ganglion for the treatment of trigeminal neuralgia has become an increasingly popular method among neurosurgeons. However, the method has recognized complications, including double vision. Although occurring infrequently, diplopia may cause the patient significant disability. To minimize the risk for this complication, we analyzed our patients with respect to the surgical technique. ⋯ By meticulous surgical technique with close attention to the anatomic position and the shape of the inflated balloon, most cases of postcompression diplopia should be avoided.