Neurosurgery
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This report describes an important technical modification in ventriculoperitoneal shunting. ⋯ The suprahepatic subdiaphragmatic space can be directly accessed in some selected patients with extensive peritoneal adhesions, resulting in successful ventriculoperitoneal shunting.
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To provide a theoretical basis for the selection of the anode-cathode configuration in spinal cord stimulation for the management pain when one percutaneous epidural electrode or two electrodes in parallel are used. ⋯ The relative positions of cathodes and anodes and their distance from the spinal cord are the major determinants of dorsal column/dorsal root activation and paresthesia distribution. The large interpatient variability of the intraspinal geometry is the main cause of differences in paresthesia coverage among patients having optimally placed electrode(s). Changes of paresthesia coverage over time are more probable when multiple electrodes are used.
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Intimate to the application of lateral transtemporal approaches to the cranial base are the identification, manipulation, and/or the sacrifice of the venous anatomy of the inferolateral temporal lobe and the superior petrosal sinus and the transection of the tentorium. This study demonstrates the relationship and variability of the venous drainage of the lateral and inferior surfaces of the temporal lobe. ⋯ An understanding of the complexity and diversity of the venous drainage complexes and their configurations is necessary to avoid venous complications during lateral cranial base surgery.
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The management of chronic pain of spinal origin continues to represent a challenge for neurosurgeons. Spinal cord stimulation for chronic intractable pain is an effective therapy in approximately 50% of patients. The present study uses a novel imaging approach, functional magnetic resonance imaging (fMRI), to examine the central effects of spinal cord stimulation. ⋯ This report is the first to describe the cerebral effects of exogenous spinal cord stimulation with fMRI. fMRI allows for the objective examination of the effects of DCS and may provide an objective means of evaluating the efficacy of DCS as a therapy for intractable pain of spinal origin.
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The goals of the study were to determine the incidence and time course of cerebral arterial spasm in patients with penetrating craniocerebral gunshot wounds, to study the relationship between vasospasm and subarachnoid hemorrhage (SAH) in these patients, and to evaluate the effects of vasospasm on outcome. ⋯ These findings demonstrate that delayed cerebral arterial spasm is a frequent complication in patients with craniocerebral gunshot wounds and is strongly associated with SAH. The frequency, time course, and severity of spasm are comparable with those observed with aneurysmal SAH and traumatic SAH caused by closed head injury. This study offers new insights into the hemodynamic pathophysiology after gunshot wounds to the brain and suggests that increased vigilance for vasospasm may be of benefit.