Neurosurgery
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Comparative Study
Bottleneck factor and height-width ratio: association with ruptured aneurysms in patients with multiple cerebral aneurysms.
Determining factors predictive of the natural risk of rupture of cerebral aneurysms is difficult because of the need to control for confounding variables. We studied factors associated with rupture in a study model of patients with multiple cerebral aneurysms, one aneurysm that had ruptured and one or more that had not, in which each patient served as their own internal control. ⋯ In a case-control study of patients with multiple cerebral aneurysms, increased bottleneck factor and height-width ratio were consistently associated with rupture.
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Comparative Study
Resection of World Health Organization Grade II gliomas involving Broca's area: methodological and functional considerations.
Advances in functional mapping have enabled us to extend the indications of surgery for low-grade gliomas (LGGs) within eloquent regions. However, to our knowledge, no study has been specifically dedicated to the resection of LGGs within Broca's area. We report the first surgical series of LGGs involving this area by focusing on methodological and functional considerations. ⋯ Our results indicate that, in patients with no aphasia despite LGGs within Broca's area, thanks to brain plasticity, the tumor can be removed while involving this "unresectable" structure without inducing sequelae and even improving the quality of life when intractable epilepsy is relieved on the condition that subcortical language connectivity is preserved.
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What is known about the cerebral aqueduct is derived mainly from the legacy of classic histology and from the most recent advanced neuroimaging technologies. In fact, although this important structure is frequently glimpsed by neurosurgeons, only limited anatomic contributions have been added by microsurgery to its direct in vivo description. A review of our surgical experience in navigating the fourth ventricle prompted us to revisit the classical anatomic descriptions of the aqueduct and compare them using the novel perspective of neuroendoscopy. ⋯ Neuroendoscopy provides a novel perspective into the inner aqueductal wall and supplies an incomparable view of the intracanalicular anatomic structures.
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Comparative Study
Ventriculoperitoneal shunt complications in California: 1990 to 2000.
Risk factors for ventriculoperitoneal (VP) shunt complications have not been assessed with population cohort data since the advent of modern surgical techniques. We examined demographic factors and VP shunt complications in a population-based retrospective cohort study of all nonfederal California hospital admissions between 1990 and 2000. ⋯ VP shunt complications are common, especially in children. Further study is needed to explain the associations between demographic factors and elevated shunt complication rates.
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Comparative Study Clinical Trial
The kinematics of anterior cervical discectomy and fusion versus artificial cervical disc: a pilot study.
Anterior cervical discectomy and fusion (ACDF) for the management of cervical spondylosis may contribute to further degenerative changes at adjacent levels secondary to abnormal spinal motion. Insertion of a Bryan Cervical Disc (AD) (Medtronic Sofamor Danek, Memphis, TN) may prevent this accelerated degeneration. This retrospective study compares the in vivo x-ray cervical spine kinematics in patients with ACDF and AD. ⋯ Patients with AD and those with ACDF demonstrated similar in vivo adjacent level kinematics within the first 24 months after anterior cervical decompression.