Neurosurgery
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Comparative Study
Preliminary results on the management of unruptured intracranial aneurysms with magnetic resonance angiography and computed tomographic angiography.
The goal was to assess the capability of magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) to replace catheter angiography in the evaluation of unruptured intracranial aneurysms. ⋯ Both MRA and CTA provide several advantages over digital subtraction angiography, in addition to reduced costs and avoidance of arterial injury and stroke. These include retrospective manipulation of data in a 360-degree format, visualization of the internal anatomy of arteries and aneurysms, three-dimensional depiction of anatomy, and rapid data acquisition. Preliminary data and a review of the literature suggest that MRA, when used in concert with CTA, can replace catheter angiography in the assessment of select patients harboring unruptured intracranial aneurysms. Although no firm conclusions or generalizations can be drawn from this small cohort of patients, it is hoped that this report will stimulate interest and further study at other institutions.
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Surgical management of cortical lesions adjacent to or within the eloquent cerebral cortex requires a critical risk: benefit analysis of the procedure before intervention. This study introduced a measure of surgical risk, based on preoperative magnetoencephalographic (MEG) sensory and motor mapping, and tested its value in predicting surgical morbidity. ⋯ Our results suggest that MEG mapping-derived FRPs can serve as powerful tools for use in presurgical planning and during surgery.
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A major drawback of currently available spinal cord stimulation (SCS) systems for the management of chronic intractable pain, especially of widespread pain patterns as in reflex sympathetic dystrophy, is the generally limited paresthesia coverage. The aim of this study is to analyze the origin of this problem and to provide solutions. ⋯ Paresthesia coverage and pain management by SCS can be improved when using electrodes as proposed.
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Neurological deterioration, typically attributed to cerebral edema, is a rare but life-threatening complication in the treatment of diabetic ketoacidosis (DKA). We report the case of a child with DKA who became comatose but demonstrated acute obstructive hydrocephalus, instead of cerebral edema. ⋯ These observations emphasize the importance of recognizing hydrocephalus as a potentially reversible cause of coma in DKA and of initiating prompt neurosurgical intervention, if warranted.