Neurosurgery
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Randomized Controlled Trial
Randomized, Prospective Double-Blinded Study Comparing 3 Different Doses of 5-Aminolevulinic Acid for Fluorescence-Guided Resections of Malignant Gliomas.
Five-aminolevulinic acid (5-ALA) is used for fluorescence-guided resections of malignant glioma at a dose of 20 mg/kg; yet, it is unknown whether lower doses may also provide efficacy. ⋯ The highest visible and measurable fluorescence was yielded by 20 mg/kg. No fluorescence was elicited at 0.2 mg/kg. Increasing 5-ALA doses did not result in proportional increases in tissue fluorescence or PPIX accumulation in plasma, indicating that doses higher than 20 mg/kg will not elicit useful increases in fluorescence.
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Neurological deterioration and mortality are frequent in neurosurgical patients transferred to tertiary centers, but the precise predictors leading to them are unclear. ⋯ Neurosurgery patients are vulnerable to deterioration in transit and exhibit several patterns predictive of mortality. Hydrocephalus, use of clopidogrel and warfarin, and intracerebral hemorrhage are each independently associated with elevated risk of deterioration and death.
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Recurrent hemorrhage is a serious neurosurgical problem in adult moyamoya disease (MMD) patients. ⋯ During the follow-up period, recurrent hemorrhagic events continued to increase and deteriorated the patients' neurological conditions. The presence of intraventricular hemorrhage was a significant risk factor of recurrent hemorrhage.
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Spinal surgery costs vary significantly across hospitals and regions, but there is insufficient understanding of what drives this variation. ⋯ After adjusting for patient factors and wage index, the Western region, hospitals with smaller bed sizes, and rural/urban nonteaching hospitals were associated with higher costs for lumbar laminectomy/discectomy and lumbar fusion.
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Tortuous and dolichoectatic vertebrobasilar arteries can impinge on the brainstem and cranial nerves to cause compression syndromes. Transposition techniques are often required to decompress the brainstem with dolichoectatic pathology. We describe our evolution of an anteromedial transposition technique and its efficacy in decompressing the brainstem and relieving symptoms. ⋯ Compressive dolichoectatic pathology directed laterally into cranial nerves and posteriorly into the brainstem can be corrected with anteromedial transposition towards the clivus. Our technique accomplishes this anteromedial transposition from an inferolateral surgical approach through the vagoaccessory triangle, with sling fixation to clival dura using aneurysm clips.