Neurosurgery
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Comparative Study
Intracranial electroencephalography with subdural grid electrodes: techniques, complications, and outcomes.
Intracranial subdural grid monitoring is a useful diagnostic technique for surgical localization in patients with intractable partial epilepsy. The rationale for the present study was to assess the morbidity of intracranial recordings and the surgical outcomes. ⋯ Subdural grid monitoring for identification an epileptogenic focus is high yield, revealing a focus in 79% of monitoring sessions. Complications rarely result in permanent morbidity (1.5%). Surgical outcome indicated that 74% of patients experienced a favorable reduction in seizure tendency.
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Significant advances have been made in the contemporary management of thoracolumbar spinal deformities, including improved segmental bony fixation, techniques for osteotomy, and mechanically powerful reduction maneuvers, which now allow the spinal surgeon to correct severe, complex, and rigid spinal deformities. However, one of the major limitations of surgical intervention has been the high complication rates associated with these surgical endeavors. ⋯ The open exposures for long-segment fixation result in additional blood loss, increased rates of infection, and prolonged immobilization caused by postoperative pain. Minimally invasive techniques attempt to overcome these drawbacks of the open exposures, and this report reviews preliminary experience in treating spinal deformities with long-segment minimally invasive internal fixation.
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Historical Article
The Harvard Neurosurgical Service at the Children's Hospital Boston and Brigham & Women's Hospital, 1912-2007.
The Harvard Neurosurgical Service at Brigham and Women's Hospital and Children's Hospital Boston has a distinguished history, beginning in 1912 when Dr. Harvey Cushing became surgeon-in-chief at the Peter Bent Brigham Hospital. After Cushing left in 1932, the Children's Hospital had a dominant role, with the creation and development of pediatric neurosurgery under Franc D. ⋯ Despite reporting on more than 2500 cases a year, the combined service continued to have a strong academic program. This was helped by a residency with two required research years, an academic day each week, faculty committed to research, strong scientific collaborations, and contributions from many visiting neurosurgeons and research fellows. In its first 94 years, the service has been a strong force in clinical, educational, political, and research efforts in neurosurgery.
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Review Case Reports Comparative Study
Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity.
Minimally invasive and interbody and instrumented fusion techniques are increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar spine. Advocates of minimal access spinal approaches list certain advantages over open procedures, including decreased postoperative pain and narcotic requirements, shorter hospital stays, less blood loss, and smaller incisions. The minimally invasive anterolateral approach allows access to the lumbar spine through the retroperitoneal space. ⋯ One patient had additional posterior segmental instrumentation placed. Mean Cobb angles in the coronal plane were 28.5 degrees preoperatively and 18.3 degrees postoperatively (P < 0.05). We also present a historical perspective on retroperitoneal spine surgery, a regional anatomic description of the lumbosacral plexus and surrounding structures, and a description of the surgical technique as related to treatment of lumbar deformity.
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To review and define principles and features of treatment for adult degenerative scoliosis, the most common cause of adult spinal deformities. ⋯ Degenerative scoliosis is a complex disorder. The primary surgical aims are to decompress the neural elements, normalize both sagittal balance and coronal and rotational deformity, fixate to the sacrum/ilium when appropriate, and optimize conditions for osteogenesis and fusion.