Neurosurgery
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Comparative Study
Three-dimensional in vivo modeling of vestibular schwannomas and surrounding cranial nerves with diffusion imaging tractography.
Preservation of cranial nerves (CNs) is of paramount concern in the treatment of vestibular schwannomas, particularly in large tumors with thinned and distorted CN fibers. However, imaging of the CN fibers surrounding vestibular schwannomas has been limited with 2-dimensional imaging alone. ⋯ Tractography and anatomic imaging were successfully combined to demonstrate the precise location of surrounding CN fibers. This technique can be useful in both neuronavigation and radiosurgical planning. Because knowledge of the course of these fibers is of important clinical interest, implementation of this technique may help decrease injury to CNs during treatment of these lesions.
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Randomized Controlled Trial Comparative Study
Postoperative fever discharge guidelines increase hospital charges associated with spine surgery.
Postoperative fever is a common sequel of spine surgery. In the presence of rigid nationally mandated clinical guidelines, fever management may consume more health care resources than is reasonably appropriate. ⋯ Postoperative fever in spine surgery patients is associated with a delay in patient discharge and increases in hospital charges. Postoperative fever discharge guidelines should be regularly and publicly subjected to appropriate cost-benefit analysis.
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Review Case Reports
Solitary paraganglioma of the hypoglossal nerve: case report.
We report the case history of solitary hypoglossal paraganglioma in a 64-year-old woman. The surgical difficulties encountered in the removal of this challenging tumor are discussed and as a literature review provided. ⋯ When a case of solitary hypoglossal paraganglioma is encountered in clinical practice, the aim of management should be mainly focused on achieving a diagnosis and preserving the hypoglossal nerve function. If there is evidence of vascularity in the lesion noted on magnetic resonance imaging, a preoperative angiogram should be obtained with a view for embolization. We decompressed the hypoglossal canal and achieved good improvement in the patient's symptoms. We recommend stereotactic radiosurgery for remnant and small hypoglossal tumors and regular follow-up with magnetic resonance imaging scans.
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Comparative Study
Morbidity of ventricular cerebrospinal fluid shunt surgery in adults: an 8-year study.
Cerebrospinal fluid (CSF) shunt procedures have dramatically reduced the morbidity and mortality rates associated with hydrocephalus. However, despite improvements in materials, devices, and surgical techniques, shunt failure and complications remain common and may require multiple surgical procedures. ⋯ Shunt surgery still carries a high morbidity rate, with a mean of 2.2 reoperations per patient in 23.3% of patients. Our risk-factor data suggest methods for decreasing shunt-related morbidity, including peritoneal routing whenever possible and special attention to preventing CSF leaks after craniotomy or external ventriculostomy.