Neurosurgery
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Cranial base metastases (CBM) are rare and have received limited attention in the medical literature. Questions remain regarding the role of surgery, if any, in the management of these tumors. ⋯ The goal of surgery for CBM is to provide symptom relief and to preserve functional status in well-selected cases. Patient selection is critical because the surgery is usually palliative, and only a minority of patients are surgical candidates. Radiation therapy remains the management option of choice for the majority of patients.
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Chronic subdural hematoma (CSDH) is commonly seen in neurosurgical practice, and the incidence is increasing. Treatment results are highly variable with respect to recurrences and complications. ⋯ The present data suggest that in surgical treatment of CSDH with burr hole craniostomy, extended preoperative corticosteroid administration is associated with a lower recurrence rate. The use of corticosteroids does not seem to be related to a higher incidence of complications and treatment-related death compared with the current literature.
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Factors during neurosurgical residency that are predictive of an academic career path and promotion have not been defined. ⋯ Defined in-training factors including number of total publications, number of first-author publications, and program size are predictive of residents choosing and succeeding in an academic career path.
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Comparative Study
An in vitro biomechanical comparison of single-rod, dual-rod, and dual-rod with transverse connector in anterior thoracolumbar instrumentation.
After thoracolumbar corpectomy, standard anterolateral instrumentation may consist of dual rods with cross-connectors. However, when the vertebral bodies are small or involved with disease, only 1 rod may be possible. ⋯ In our in vitro model of anterior spinal stabilization after corpectomy and grafting, a single-rod construct is significantly less rigid than the intact spine. Addition of a second rod returns the rigidity of the spine to the intact state. A dual-rod cross-connector construct is significantly more rigid than a single-rod construct.
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Lesions in the insula and basal ganglia can be risky to resect because of their depth and proximity to critical structures, particularly in the dominant hemisphere. Transsylvian approaches shorten the surgical distance to these lesions, preserve perisylvian temporal and frontal cortex, and minimize brain transgression. ⋯ Transsylvian-transinsular approaches safely expose vascular pathology in or deep to the insula while preserving overlying eloquent cortex in the frontal and temporal lobes. The anterior transsylvian-transinsular approach can be differentiated from the posterior approach based on technical differences in splitting the sylvian fissure and anatomic differences in final exposure. Discriminating patient selection and careful microsurgical technique are essential.