Surg Neurol
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Randomized Controlled Trial Comparative Study Clinical Trial
Superficial vs combined cervical plexus block for carotid endarterectomy: a prospective, randomized study.
The present study compares combined and superficial cervical plexus block in patients submitted to carotid endarterectomy (CEA) in terms of anesthetic efficacy, satisfaction of the patient and surgeon, complications resulting from the type of anesthesia, and final outcome. ⋯ Superficial cervical anesthetic block shows the same efficacy as combined block, with the surgical conditions being closely similar. The incidence of complications related to the anesthetic technique is higher for combined block. The type of block does not influence the final outcome of the patients.
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Intraoperative positioning nerve injuries are regrettable complications of surgery thought to arise from stretch and/or compression of vulnerable peripheral nerves. Generally thought to be preventable, these injuries still occur in patients despite rigorous preventative measures. ⋯ Prevention remains the mainstay of the management of positioning injuries. Diagnosed and managed appropriately, these lesions typically improve completely over time.
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The aim of this study was to analyze the effect of a surgical management protocol and other important clinical features on the prognosis of patients who had penetrating orbitocranial gunshot injuries. ⋯ The prognosis of the injury depends on the course of the bullet or shrapnel fragment and the interdisciplinary care. An extensive preoperative evaluation of penetrating orbital trauma and a combined ophthalmic and neurosurgical approach are recommended to minimize the morbidity of the patients. However, complete removal of the foreign material in a deep or ventricular localization is not mandatory because careful debridement and tight closure of dura provides desired outcome. Evaluation of trauma mechanism and injury characteristics according to the Ocular Trauma Classification System seems to predict accurately the visual outcomes in this series.
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We report our experience with the minimally invasive supraorbital approach to aneurysms of the ipsilateral anterior cerebral circulation. ⋯ Selected anterior cerebral circulation aneurysms can be clipped with low morbidity, using an ipsilateral minicraniotomy preserving the orbital rim, and without using an endoscope. The types of aneurysm selection criteria and operative equipment used are described.
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Nerve repair with fibrin glue is an alternative to conventional suture technique, although there is no definitive experimental evaluation of the 2 techniques. This experimental study was undertaken to evaluate nerve regeneration after sciatic nerve repair with fibrin glue and to compare it with repair performed with suture and a combination of both techniques. ⋯ In a rat model, nerve repair using fibrin glue provided better conditions for regeneration than suture after sciatic nerve transection.