Neurosurgery
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Greek poets from the archaic and early classical periods frequently depicted doctors alongside political and military leaders and victorious sportsmen. The mythology of ancient physicians found in such sources may give us clues as to how doctors could be viewed and represented by other segments of society, then and now. ⋯ The portrayal of physicians in ancient poetry and sculpture may inform modern neurosurgery and organized medicine about strategies by which we may best serve our patients and elevate our profession.
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Case Reports
U-shaped sacral fracture and lumbosacral dislocation as a result of a shotgun injury: case report.
Gunshot wounds to the spine and/or sacrum rarely cause spinal instability. Our goal is to report the first case of a U-shaped sacral fracture and lumbosacral dislocation caused by a gunshot injury to the spine. ⋯ Close-range shotgun injuries result in massive destruction of tissues. As opposed to civilian injuries, a different approach must be taken to prevent infectious complications. A bilateral lumbopelvic fixation using long iliac screws effectively restored lumbosacral pelvic stability.
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Atypical meningioma (AM) patients often undergo gross total resection (GTR) at the time of presentation, but subsequent prognosis and optimal management remain unclear. We sought to define the long-term recurrence rate of AMs after GTR, along with factors predicting recurrence, including postoperative radiation. ⋯ After GTR without postoperative radiation, AMs have a high recurrence rate. Most recurrences occurred within 5 years after resection. Recurrences caused numerous reoperations per patient and shortened survival. Our finding suggesting lower recurrence rates in patients undergoing immediate postoperative radiation should be investigated in larger, prospective series.
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In patients with moyamoya disease, surgery to revascularize the ischemic brain is a recommended treatment. However, there are a few patients who require additional revascularization surgery because of progression of the disease. Even patients who show no postoperative ischemic symptoms at first may experience late deterioration. We performed additional surgery for such lesions using occipital artery (OA)-posterior cerebral artery (PCA) bypass with indirect revascularization. The efficacy of the procedure is reported. ⋯ OA-PCA anastomosis with indirect revascularization was effective for postoperative ischemia that showed symptoms in the anterior cerebral artery and PCA territories as a result of progression of a PCA lesion.