Neurosurgery
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The efficacy of endoscopic transsphenoidal surgery (ETS) for Cushing disease has not been clearly established. ⋯ ETS for Cushing disease provides high rates of remission with low rates of complications regardless of size. Although patients with a history of previous surgery are less likely to achieve remission, the majority can still achieve remission following treatment.
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The prognosis and treatment of astrocytomas, which are primary brain tumors, vary depending on the grade of the tumor, necessitating a precise preoperative classification. Magnetic resonance spectroscopy (MRS) provides information about metabolites in tissues and is an emerging noninvasive tool to improve diagnostic accuracy in patients with intracranial neoplasia. ⋯ Ex vivo MRS can differentiate astrocytomas based on their metabolic profiles.
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There is no consensus on which material is best suited for repair of cranial defects. ⋯ Complications after using titanium plate for primary or secondary cranioplasty were common (29%) and associated with an increased length of hospital stay. Infection was a major complication (16%), and this suggested that more vigorous perioperative infection prophylaxis is needed for titanium plate cranioplasty.
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Biography Historical Article
Everything to gain: Sir Hugh Cairns' treatment of central nervous system infection at Oxford and abroad.
Antibiotics have revolutionized survival from central nervous system (CNS) infections. Sixty years after the death of Sir Hugh Cairns, we present archive material of historical interest from the Radcliffe Infirmary in Oxford from the time of his first trials of penicillin for CNS infection. We discuss Cairns' important wartime and subsequent contributions to antibiosis in CNS infection and include drawings by Audrey Arnott illustrating the surgical techniques used to treat abscesses at the time.
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Endovascular therapy has largely replaced microsurgical clipping for the treatment of basilar tip aneurysms. ⋯ In our current management of basilar tip aneurysms, the majority can be treated via endovascular means, albeit with the expectation of a higher percentage of residual lesions and recurrences. Microsurgery is still appropriate for aneurysms with complex neck morphologies and in young patients desiring a more durable treatment.