Neurosurgery
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The use of image guidance during spinal surgery has been limited by several anatomic factors such as intervertebral segment motion and ineffective spine immobilization. In its current form, the surgical field is coregistered with a preoperative computed tomography (CT), often obtained in a different spinal confirmation, or with intraoperative cross-sectional imaging. Stereovision offers an alternative method of registration. ⋯ Semi-automated registration of a spinal surgical field using stereovision is possible with accuracy that is at least comparable to current landmark-based techniques.
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Comparative Study
Posterior Inferior Cerebellar Artery/Vertebral Artery Subarachnoid Hemorrhage: A Comparison of Saccular vs Dissecting Aneurysms.
Two distinct categories of aneurysms are described in relation to the posterior inferior cerebellar artery (PICA) and vertebral artery (VA): saccular (SA) and dissecting (DA) types. This distinction is often unrecognized because abnormalities here are uncommon and most studies are small. ⋯ The presentation, clinical course, and outcomes differ in patients with DA vs SA of the PICA and VA.
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There have been some reports on the use of intra-arterial tirofiban in ruptured intracranial aneurysms, but few studies have reported on the use of 24 h of intravenous tirofiban infusion in patients with subarachnoid hemorrhage. ⋯ Intravenous tirofiban, as a monotherapy or in addition to intra-arterial tirofiban for thrombotic complications, seems to be useful as a treatment for acute aneurysm. However, alternatives to tirofiban should be considered if an associated hematoma is discovered before a patient receives a tirofiban infusion.
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Elderly patients with glioblastoma have an especially poor prognosis; optimizing their medical and surgical care remains of paramount importance. ⋯ Further optimization of the medical and surgical care of elderly glioblastoma patients may be achieved by providing more beneficial therapies while avoiding unnecessary resection in those not likely to receive benefit from this intervention.
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Case Reports
Hourglass-Like Constriction of the Brachial Plexus in the Posterior Cord: A Case Report.
Hourglass-like constrictions are fascicular conditions confirmed definitively by interfascicular neurolysis. Certain peripheral nerves have vulnerable areas such as around the elbow in the posterior interosseous nerve. We report the first hourglass-like constriction in the brachial plexus supplying the radial innervated forearm musculature. Preoperative magnetic resonance imaging (MRI) findings of the brachial plexus were consistent with neuralgic amyotrophy (NA). ⋯ Hourglass-like constrictions can occur in the brachial plexus. Although surgical approaches for the constrictions are still controversial, several reports demonstrated their effectiveness. Meanwhile, concerning NA treatment, evidence on the surgical intervention is lacking. Brachial plexus MRI might help in discerning the lesion and planning treatment options including surgical interventions. Hourglass-like constrictions are a possible etiology for certain NA patients with residual symptoms or paresis.