Neurosurgery
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Historical Article
The development of neurosurgery at the National Hospital for Neurology and Neurosurgery, Queen Square, London, England.
The National Hospital for Neurology and Neurosurgery, Queen Square, London is one of the oldest clinical neuroscience hospitals in the world. It was formed from the fusion of itself with the Maida Vale Hospital in 1948. ⋯ It has had many distinguished neurosurgeons on its staff, whose history from Sir Victor Horsley to the present is described with particular reference to the development of the specialty of neurosurgery. The current neurosurgical staff and future developments of neurosurgery at the hospital are also elucidated.
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We previously reported our technique of selective microforaminotomy via an anterolateral approach for the treatment of spondylotic radiculopathy. We now report the clinical long-term results. ⋯ The technique of microsurgical cervical nerve root decompression by selective microforaminotomy via an anterolateral approach is safe and efficient for the treatment of spondylotic radiculopathy. The morbidity rate is low. Clinical results are good after a long-term follow-up period. This technique allows the preservation of cervical motion and spinal stability. The results compare favorably to those of the literature.
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Meta Analysis Controlled Clinical Trial
Risk of shunt-dependent hydrocephalus after occlusion of ruptured intracranial aneurysms by surgical clipping or endovascular coiling: a single-institution series and meta-analysis.
To compare the risk of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by clipping versus coiling. ⋯ Clipping of a ruptured aneurysm may be associated with a lower risk for developing shunt dependency, possibly by clot removal. This might influence long-term outcome and surgical decision making.
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Although volatile anesthetics have been widely accepted in anesthetic management for neurosurgery, they reduce vascular resistance, resulting in increased cerebral blood flow and increased intracranial pressure (ICP). In patients with elevated ICP who undergo craniotomy, the increase in ICP during surgery from inhaled anesthetics can make the surgery more difficult, thereby increasing the risk of ischemic cerebral insults. Total intravenous anesthesia (TIVA) using propofol and analgesic drugs (remifentanil or fentanyl) and excluding simultaneous administration of any inhaled drugs is being used in patients undergoing craniotomy because of its potential to reduce ICP and ease access to the operative site. ⋯ The impact of TIVA on ICP, brain swelling, and access to the operative site in patients with severely elevated ICP has yet to be evaluated and is the subject of a future study at our institution.