British journal of neurosurgery
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Virtual reality (VR) simulators have been created for various surgical specialties. The common theme is extensive use of graphics, confined spaces, limited functionality and limited tactile feedback. A development team at the University of Nottingham, UK, consisting of computer scientists, mechanical engineers, graphic designers and a neurosurgeon, set out to develop a haptic, e.g. tactile simulator for neurosurgery making use of boundary elements (BE). ⋯ A limited audit was done by neurosurgical users confirming the potential of the simulator as a training tool. This paper focuses on the application of the computational method and refers to the underlying mathematical structure. Full references are included regarding the mathematical methodology.
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The aim of this study is to define the indications to endoscopy versus other surgical procedures in the management of suprasellar arachnoid cysts from a personal series and an extensive literature review. Five symptomatic patients (two children and three adults) with suprasellar arachnoid cysts were treated by endoscopic fenestration in our neurosurgical unit. The endoscopic procedure consisted of ventricle-cyst-cisternostomy in three cases and ventricle-cystostomy in two. ⋯ The literature review includes 102 patients treated by endoscopic fenestration and 74 treated by other procedures, including microsurgical cyst resection through craniotomy (38 cases), shunt of the cyst (21 cases) and percutaneous ventricle-cystostomy (15 cases). Among the reviewed cases, the rate of cure or improvement was 90% (92 among 102 cases including ours) after endoscopy and 81% (60 among 74 cases) after other surgical procedures. The results of this study suggest that endoscopic ventricle-cyst cisternostomy is the best treatment for suprasellar arachnoid cysts, because it is less invasive, provides the best results and avoids shunt dependency in most cases.
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Traumatic brain injury (TBI) is the commonest cause of death and disability in young adults living in industrialised countries. Recently, several studies have shown that hypopituitarism is a common complication of head trauma, with a prevalence of at least 25% among patients who were studied months or years following injury. ⋯ This article discusses the published reports on neuroendocrine dysfunction in TBI patients and the natural history of this disorder. The potential impact of posttraumatic hypopituitarism on recovery and rehabilitation after injury will also be examined, as well as the need for the identification, and appropriate and timely management of hormone deficiencies in order to reduce morbidity, aid recovery, and avoid the long-term complications of pituitary failure.
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Comparative Study
Cauda equina syndrome: what is the correlation between clinical assessment and MRI scanning?
The indications for magnetic resonance imaging (MRI) in suspected cauda equina syndrome, and the urgency for this investigation are regularly disputed. In this study we assess the ability of neurosurgical residents to predict on clinical grounds in which patients with cauda equina syndrome (CES) this was due to prolapsed intervertebral disc thereby justifying a request for urgent MR imaging. ⋯ Because it is impossible in a significant proportion of patients to exclude the diagnosis of prolapsed intervertebral disc in the context of referral with suspected cauda equina compromise the authors recommend urgent MRI assessment in all patients who present with new onset urinary symptoms in the context of lumbar back pain or sciatica.