Neurosurgery
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To develop a new saccular aneurysm model in vitro using elastase to study aneurysm initiation, growth, and rupture and to create a new in vivo aneurysm model to test endovascular therapies. ⋯ After empirically testing several methods of elastase delivery, we were able to induce saccular, bifurcation-type aneurysms in animal arterial specimens. These aneurysms are histologically similar and more authentic than surgical models. The procedure is easy and reproducible. Our results suggest a possible enzymatic role in aneurysm formation and highlight the dramatic effects of selective arterial elastic damage. Also, the rapid growth of our experimental aneurysms may reflect the speed of the natural process.
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To review and analyze a contemporary series of 15 neonates who were treated for posterior fossa subdural hematomas (PFSDHs) during the era of computed tomography and magnetic resonance imaging. ⋯ PFSDHs are rare but important lesions to diagnose early in the neonatal period. Surgery can be life-saving when performed in a timely manner for signs and symptoms of brain stem dysfunction. A search for an underlying cause predisposing to a PFSDH may, on occasion, reveal a coagulation disturbance or a neoplasm that will require additional therapeutic considerations.
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The purpose of this study was to clarify the risk of rupture of unruptured intracranial aneurysms among large groups of patients with various underlying diseases or conditions. ⋯ The risk of rupture of unruptured aneurysms is high, especially for multiple aneurysms, but there are no significant differences in the risk of rupture according to the underlying disease or the aneurysm location. Radical treatment should be considered for patients with unruptured intracranial aneurysms.
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The purpose was to identify the prevalence, causative factors, injury types, and associated injury patterns in multitrauma patients who sustained brachial plexus injuries. ⋯ Brachial plexus injuries afflict slightly more than 1% of multitrauma victims. Motorcycle and snowmobile accidents carry especially high risks, with the incidence of injury approaching 5%. Head injuries, thoracic injuries, and fractures and dislocations affecting the shoulder girdle and cervical spine are particularly common associated injuries. Supraclavicular injuries are more common, are of more severe grade, more often require surgery, and are associated with worse prognosis, compared with infraclavicular injuries.