Neurosurgery
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To evaluate the feasibility of PoleStar N20 (Medtronic Surgical Navigation Technologies, Louisville, KY), an ultra-low-field intraoperative magnetic resonance imaging (iMRI) system during resection control of pituitary macroadenomas and to compare intraoperative images with postoperative 1.5-T MRI images obtained 3 months after the procedure. ⋯ Ultra-low-field 0.15-T iMRI is a safe, helpful, and feasible tool for navigation and tumor resection control in patients with pituitary macroadenomas. Total anesthesia and operation times are prolonged, but iMRI adequately documents the extent of tumor resection. In this series, the PoleStar system increased the rate of resection without disrupting the neurosurgical workflow.
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Comparative Study
Fever burden and functional recovery after subarachnoid hemorrhage.
Fever is associated with worse outcome after subarachnoid hemorrhage, but there are few prospective data to quantify this relationship. ⋯ Cumulative fever burden was associated with worse outcomes in good-grade patients and potential late recovery in poor-grade patients. Effective fever control in febrile subarachnoid hemorrhage patients may improve functional outcomes and hasten recovery.
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Multicenter Study Comparative Study
Validation of an aneurysmal subarachnoid hemorrhage grading scale in 1532 consecutive patients.
The two most commonly used aneurysmal subarachnoid hemorrhage grading scales are the Hunt and Hess and World Federation of Neurological Societies scales. Neither has achieved universal acceptance, however, owing to concerns regarding either subjectivity or lack of correlation with outcomes, respectively. A grading scale based entirely on the Glasgow Coma Scale (GCS) was recently proposed. We have prospectively evaluated the GCS grading system and compared it with the Hunt and Hess and World Federation of Neurological Societies scales for predictive accuracy. ⋯ The GCS grading system is more strongly associated with outcomes than either the Hunt and Hess or World Federation of Neurological Societies scales, and it is an equivalent to a slightly better predictor of Glasgow Outcome Scale outcomes. Its simplicity, proven inter-rater reliability, and wide level of familiarity among health care personnel render the GCS grading system a superior grading scale for aneurysmal subarachnoid hemorrhage severity, warranting its consideration for universal use.
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To systematically analyze patient outcomes after repeat transsphenoidal (TS) surgery for recurrent Cushing's disease. ⋯ Although the success of repeat TS surgery for recurrence of Cushing's disease is less than that of initial surgery, a second procedure offers a reasonable possibility of immediate remission. If the operation is not successful, other treatments, including pituitary radiation, medical therapy, and even bilateral adrenalectomy, are required.
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Case Reports Comparative Study
Expanded endoscopic endonasal approach for treatment of clival chordomas: early results in 12 patients.
We report our recent experience with an expanded purely endoscopic endonasal approach for the treatment of clival chordomas. ⋯ The expanded endoscopic endonasal approach is a valid minimally invasive alternative for the treatment of centrally located clival chordomas or as an adjunct for the central part of chordomas with lateral extension. The early results of this technique indicate at least equivalency to more extensive open approaches, and its versatility may widen the horizon of surgical management of these aggressive lesions. The challenge with the cerebrospinal fluid leakage is being addressed with novel local flap repair techniques. This approach should be in the armamentarium of cranial base surgeons as an option in the management of clival chordomas.