Neurosurgery
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Review Case Reports
Preserve the nerve: microsurgical resection of peripheral nerve sheath tumors.
Using a fascicle-sparing approach, schwannomas and nonplexiform neurofibromas can often be removed without causing neurological deficit or neuropathic pain. This article provides a step-by-step description of how to remove these benign tumors using microsurgical techniques.
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The aim of this study is to establish the safety and efficacy of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients with disabling motor fluctuations performed with an expedient procedure with limited intraoperative mapping. ⋯ This STN DBS surgical technique for PD is expedient with effective outcomes and low complication rates.
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Comparative Study
Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up.
To evaluate the midterm results of intracranial stent-assisted coil embolization in the treatment of wide-necked cerebral aneurysms and to assess the efficacy of various strategies used in stent deployment. ⋯ These results indicate that Neuroform stent-assisted coil embolization is a safe and effective technique in the treatment of wide-necked cerebral aneurysms. Further studies are needed to evaluate the long-term durability of stent-assisted aneurysm occlusion and tolerance to the stent.
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Comparative Study
Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke.
We have frequently observed the development of postoperative communicating hydrocephalus in patients undergoing decompressive hemicraniectomy. This condition may persist in some patients after cranioplasty and require permanent cerebrospinal fluid (CSF) diversion. To confirm an independent correlation between hemicraniectomy and the development of communicating hydrocephalus, and to detail the frequency and potential clinical factors contributing to this complication, we evaluated our series of patients undergoing hemicraniectomy for life-threatening increases in intracranial pressure secondary to ischemic or hemorrhagic stroke. ⋯ Communicating hydrocephalus is an almost universal finding in patients after hemicraniectomy. Delayed time to cranioplasty is linked with the development of persistent hydrocephalus, necessitating permanent CSF diversion in some patients. We propose that early cranioplasty, when possible, may restore normal intracranial pressure dynamics and prevent the need for permanent CSF diversion in patients after hemicraniectomy.
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Comparative Study
Atlanto-occipital dislocation: part 1--normal occipital condyle-C1 interval in 89 children.
Although atlanto-occipital dislocation has long been recognized as an extremely unstable and often lethal injury, no single radiodiagnostic criterion published to date has achieved failure-proof status. This is because most existing diagnostic tests exploit bony landmarks remote from the injured condyle-C1 (OC1) joint so that patient positioning could inadvertently line up these landmarks and conceal actual disruption of the joint. Many of the landmarks used are wide apart and/or noncoplanar; their measurements are subject to errors related to x-ray angle, target-film distance, and superimposed bony outlines. We propose using the actual occipital condyle-C1 interval (CCI) obtained from high-resolution reconstructed computed tomographic scans as the indicator for OC1 joint disruption. We hypothesize that the normal CCI is very small and has great left-right symmetry and that atlanto-occipital dislocation is always manifested by an abnormal widening of the CCI and/or by left-right joint asymmetry irrespective of the shifting of other remote bony landmarks. Part I of this study establishes standard normal values for CCI in children. ⋯ The normal OC1 joint in children 0 to 18 years is tightly held together by ligaments with a mean CCI of 1.28 mm in the 89 subjects tested. There is great left-right joint symmetry in both CCI and conformational anatomy. CCI and left-right symmetry do not appear to change significantly with age. It is reasonable to set a maximum CCI as a discriminator between normal and disrupted OC1 joints to indicate atlanto-occipital dislocation.