Neurosurgery
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To report an operative technique using 2 microcatheters placed in different arterial pedicles for Onyx (ev3 Neurovascular, Inc, Irvine, CA) embolization of cerebral arteriovenous malformations (AVMs). ⋯ The 2-microcatheter technique for embolization of AVMs with Onyx was performed safely. The technique allowed for less interruptions of injection and better control of the reflux of Onyx in the arterial pedicle during treatment. This technique presents an alternate approach to conventional AVM embolization.
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Since the pioneering studies of human thalamic anatomy based on histology and binding techniques, little new work has been done to bring this knowledge into clinical practice. ⋯ It seems possible to identify the subcompartments of the thalamus by spontaneous MRI contrast, allowing a tissue architectural approach. In addition, the MRI tissue architecture matches the earlier subcompartmentalization based on cyto- and chemoarchitecture. This true 3D anatomic study of the thalamus may be useful in clinical neuroscience and neurosurgical applications.
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Dural injury is a common complication of lumbar spine surgery. Primary closure is the "gold standard." ⋯ We describe the application of an aneurysm clip to treat a recurrent durotomy where the standard practice of sutured closure failed. Aneurysm clips offer a quick, safe, and secure manner to close dura without risking spinal destabilization. They offer significant benefit to already torn, friable dura. Postoperatively, patients have no limitations and are therefore prevented from being exposed to additional risks associated with bed rest. Aneurysm clips are cost and clinically effective in the management of dural injuries.
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Racial disparities in American health care outcomes are well documented. We investigated racial disparities in hospital mortality and adverse discharge disposition after brain tumor craniotomies performed in the United States from 1988 to 2004. We explored potential explanations for the disparities. ⋯ Black patients died more often or had an adverse discharge disposition after tumor craniotomies in the United States in the period studied (1988-2004). Blacks had more severe disease at presentation and were treated at lower-volume hospitals for surgery. Other socially defined patient groups also showed disparities in access and outcomes of care.
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To develop a safe and accurate method of image-guided placement of instrumentation in the upper cervical spine and occiput in which the reference arc is fixed to the headholder. ⋯ This technique allows safe and accurate placement of instrumentation in the posterior occipitocervical junction using 3-dimensional image guidance in which the reference arc is attached to the headholder.