Neurosurgery
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Comparative Study
Role of radiation therapy in the treatment of cerebral oligodendroglioma: an analysis of 57 cases and a literature review.
Fifty-seven cases of histologically confirmed cerebral oligodendroglioma treated at the Cleveland Clinic between 1950 and 1980 were reviewed. No difference in the 5-year survival rate was seen in patients treated with postoperative radiation therapy vs. operation alone. These data are compared to previously published series with special emphasis on the role of radiation therapy.
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Biography Historical Article
A revisit with Leo M. Davidoff, M.D.--a titan of his time: some personal notes (1898-1975).
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Between 1963 and 1980, one or more posterior-lateral foraminotomies were performed for simple cervical radiculopathy as the sole operative procedure for 736 patients. One hundred three patients (14%) required a second posterior procedure, but only 24 (3%) cases represented true recurrent radiculopathy. There were 13 minor complications (1.5%) and no deaths or detectable incidence of air embolism. ⋯ The mean length of time to return to work or other "normal" activities was 9.4 weeks. The mean length of follow-up time was 146 weeks (2.8 years). There was an associated incidence of significant lumbar disc and/or foraminal disease requiring operation of 33.4%.
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Recent reports have suggested that peripheral neurectomy with the CO2 laser may be effective in preventing subsequent neuroma formation. To study this question further, we performed bilateral sciatic nerve sections in 31 rats using a steel scalpel on one nerve and a CO2 laser on the opposite side. The animals were killed 30 days after neurectomy and specimens were removed for gross observation, light microscopy, and electron microscopy. ⋯ Analysis of axon composition studies revealed that both neuromas had a greater density of axons and a higher percentage of small diameter myelinated and unmyelinated axons as compared to control nerves. Laser neuromas had more axons per unit area than scalpel neuromas, but the percentage composition of axons was very similar in the two groups. We could find no evidence in the rat sciatic nerve model that CO2 laser neurectomy is less likely to result in neuroma formation than is conventional scalpel neurectomy.
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Six patients representing seven cases of spontaneous (nontraumatic) saphenous neuralgia secondary to entrapment of the nerve in the subsartorial canal are presented. All patients complained of medial knee and leg pain. Clinical findings included tenderness over the subsartorial canal and sensory changes in the cutaneous distribution of one or both terminal branches of the saphenous nerve. ⋯ All patients were treated operatively, which resulted in symptomatic improvement. All six patients initially underwent external neurolysis; however, three patients required saphenous neurectomy for recurrent symptoms. Saphenous neuralgia should be considered in the differential diagnosis of medial lower extremity pain.