Neurosurgery
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We determined whether the accuracy of lumbar pedicle screw placement is optimized by performing a laminectomy before screw placement with screw entry point and trajectory being guided by pedicle visualization and palpation (Technique 1). This technique was compared with a technique using anatomic landmarks for pedicle screw placement (Technique 2). The biomechanical stability of the instrumented constructs, in the absence and presence of a laminectomy, was also compared. ⋯ All screw placements were grossly within the confines of the pedicles, regardless of technique, as evidenced by computed tomographic analysis. Furthermore, the anatomic landmark technique and the open laminectomy technique yielded biomechanically equivalent pedicle screw and rod-fixated constructs.
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Comparative Study
Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale.
We developed a modification of the Fisher computed tomographic rating scale and compared it with the original Fisher scale to determine which scale best predicts symptomatic vasospasm after subarachnoid hemorrhage. ⋯ The modified Fisher scale, which accounts for thick cisternal and ventricular blood, predicts symptomatic vasospasm after subarachnoid hemorrhage more accurately than original Fisher scale.
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Complex tumors OF the glomus jugulare present a surgical challenge because of their difficult location, extreme vascularity, and involvement with multiple cranial nerves. Modern microneurosurgical and cranial base techniques have enabled safe total removal of these complicated tumors. We describe a one-stage transjugular posterior infratemporal fossa approach for radical resection of glomus jugulare tumors located around the jugular foramen, the lower clivus, and the high cervical region from an anterolateral direction. ⋯ Total exposure of the jugular foramen can be achieved, and multidirectional approaches can be performed, including infralabyrinthine/suprajugular, retrosigmoid/transcondylar/infrajugular, and transjugular exposures. Exposure of the vertical C7 segment of the infratemporal internal carotid artery and the lower clivus can be performed without permanent rerouting of the facial nerve. The details of this approach are described and illustrated in a stepwise fashion, and the microsurgical anatomy is reviewed.
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Stroke is a leading cause of morbidity and mortality in the United States. Recent animal studies have implicated the complement system in cerebral ischemia/reperfusion injury and suggest that complement inhibition may improve stroke outcomes. To assess the applicability of these findings to humans, we evaluated the characteristics and time course of human complement activation after stroke. ⋯ C3a is acutely elevated after human ischemic stroke, C5a shows delayed elevations 7 to 14 days after cerebral ischemia, and sC5b-9 is acutely depressed after stroke. Together, these data confirm complement activation after stroke and suggest that this activation is a heterogeneous process, with varying responses for different components.