Neurosurgery
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Comparative Study
Subdural motor cortex stimulation for central and peripheral neuropathic pain: a long-term follow-up study in a series of eight patients.
In certain chronic neuropathic pain (CNP) conditions, extradural electrode implantation is preferred to a subdural location for motor cortex stimulation (MCS) therapy, but the rationale for this preference remains debatable. We provide documented long-term results of subdural MCS in CNP. ⋯ In this small series, subdural MCS seemed a tolerable approach in the long term for CNP patients. In addition, subdural MCS provided a therapeutic effect comparable to that obtained with extradural placement.
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Comparative Study
Balance deficits after sports-related concussion in individuals reporting posttraumatic headache.
Posttraumatic headache (PTH) may affect neurocognition after sports-related concussion. To our knowledge, no studies have examined how PTH affects balance after concussion using dynamic posturography. The purpose of this study is to compare balance after concussion between athletes reporting PTH and athletes not reporting PTH. ⋯ Current literature proposes that PTH is associated with cognitive deficits. Our study indicates that PTH may also contribute to increased balance deficits. We believe the deficits may be a result of increased sensory organization challenges after injury. Clinicians should be mindful of these findings when managing concussed athletes reporting headache.
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Total sacrectomies are performed for extensive en bloc tumor resections. Exposure traditionally combines a posterior approach with a laparotomy to facilitate vascular control. We present a case of a total en bloc sacrectomy performed entirely through the posterior approach, thereby avoiding the need for a laparotomy. ⋯ With the use of interspace distraction and sacral elevation to facilitate vascular control, a total sacrectomy was performed without the need for the anterior exposure of a laparotomy.
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The goal of this report is to analyze the hemodynamic characteristics of low- and high-flow arteriovenous malformations (AVM) using computerized electrical models. ⋯ These electrical models seem to be useful in simulating and studying the behavior of flow and pressure in the different parts of the AVM nidus (arterial, arteriolar, arteriolar-venular, venular, venous) before and after treatment. The models can also be used to devise and simulate new treatment strategies that might lead to improved treatment of these highly complex vascular malformations of the brain.
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Deep arteriovenous malformations of the basal ganglia and thalamus have an aggressive natural history and present a therapeutic challenge. More often than not, these lesions are deemed "inoperable" and are treated expectantly or with stereotactic radiosurgery. ⋯ Interestingly, these same factors can point toward surgery. We present a discussion of the microsurgical techniques involved in managing these lesions, with an emphasis on situations that allow these lesions to be approached surgically.