Surg Neurol
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Clinical Trial
Application of neuronavigator coupled with an operative microscope and electrocorticography in epilepsy surgery.
Application of neuronavigator coupled with an operative microscope and electrocorticography (ECoG) is a new trial for epilepsy surgery for achieving better seizure outcome and better efficiency for lesionectomy. We used a neuronavigator coupled with a microscope to delineate the magnetic resonance image-detected lesion for lesionectomy and used ECoG for evaluation of the epileptogenic foci. There were 46 patients with medically intractable partial seizures who underwent craniotomy for epilepsy surgery. ⋯ The complication rate in our study was 8.7%. Neuronavigator coupled with a microscope provides efficacy and safety to complete lesionectomy, which is a key point of seizure outcome. Intraoperative ECoG is valuable for evaluating the epileptogenic foci for epilepsy surgery especially for lesions at the temporal lobe.
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Epidermoid cysts involving the cavernous sinus are rare lesions. They can be divided into 3 different categories: extracavernous, interdural, and true intracavernous. ⋯ Postoperative outcome with preservation of neural and vascular structures in cavernous epidermoid cysts is more likely related to surgical strategy than to tumor localization. Independent of the different tumor origins in these cases, a subtotal resection is usually sufficient to achieve postoperative improvement of the symptoms without additional morbidity.
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Medical subspecialization is a response to rapidly expanding technology and knowledge. Although beneficial to patient care, it poses a challenge to the current infrastructure of resident education. This article analyzes the advent of subspecialization, the current template of postgraduate neurosurgical education, the impact of subspecialization on postgraduate neurosurgical education, and, finally, suggests strategies to optimize professional education in the face of an increasingly subspecialized field.