Neurosurgery
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To evaluate the efficacy of anterior surgery for the treatment of cervical spondylotic myelopathy, we have reviewed our experience with anterior cervical corpectomy (ACC) at the University of Florida, specifically analyzing neurological outcomes and complications. These results have been compared with historical control subjects receiving laminectomy or "no treatment." ⋯ We conclude that ACC is a safe and effective treatment for cervical spondylotic myelopathy. In an average of 39 months, ACC showed improved results in terms of myelopathy scores, compared with historical control subjects receiving either no treatment or laminectomy. Age, gender, preoperative myelopathy severity, and extent of disease were not negative predictors of clinical outcomes.
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Few published studies have focused specifically on the unique management issues encountered in treating patients with arteriovenous malformations (AVMs) and associated intracranial aneurysms. The primary objective of this study was to retrospectively review the clinical and radiographic features of these patients. ⋯ Aneurysms associated with AVMs are at risk for rupture before, during, and immediately after treatment of the AVMs. New aneurysms may arise in patients with high-flow AVMs. The risk of intracranial hemorrhage from either source is higher in female patients. To reduce the complications of intracranial hemorrhage in these patients, we recommend a management protocol designed to treat the aneurysms by surgical or endovascular means before administering definitive therapy for the AVMs. Meticulous intraoperative blood pressure control and fluid management during aneurysm surgery is critical to avoid hemorrhage from the AVMs.
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In recent years, new devices for epidural pressure (EDP) measurement have been developed, with claims of improved accuracy. However, there have been no new data from simultaneous pressure measurements to reverse the skepticism regarding this technique. ⋯ The reliability of EDP measurement has not improved, compared with 10 years ago. Using this technique, one must be aware of the possibility of overestimating intracranial pressure by more than 10 mm Hg and the possibility of significant drifting of EDP over time, which argues against the use of this method even for trend analysis.
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Transcranial motor evoked potentials (tc-MEPs) are used to monitor the spinal cord intraoperatively. Volatile anesthetics considerably depress amplitudes of tc-MEPs. This study was undertaken to determine whether multipulse stimulation might overcome this depressant effect. ⋯ These data suggest that despite the powerful depressant effects of isoflurane on myogenic motor responses, tc-MEP monitoring during isoflurane anesthesia may be feasible, provided that multipulse stimulation paradigms are used and the concentration of isoflurane does not exceed 1 minimal anesthetic concentration unit.
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Before 1937, members of the Department of Surgery and Gynecology practiced emergency neurosurgery at the University of Virginia in the same fashion as in other hospitals in the United States. In 1937, Claude C. Coleman, Chairman of the Department of Neurosurgery at the Medical College of Virginia in Richmond, organized a Division of Neurosurgery as part of the Department of Surgery and Gynecology at the University of Virginia. ⋯ Laws, Jr., in 1992, Dheerendra Prasad in 1995, Gregory Helm in 1996, and Mark Shaffrey in 1997. Resident training has been a priority of the Department of Neurosurgery; many academic neurosurgeons were trained and practiced their specialty in the Department early in their careers. Sixty years after its foundation, the Department of Neurosurgery continues its commitment to patient care, research, and the "... instruction of those who come after us."