Surg Neurol
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We report our experience with keyhole approaches as favorable treatments for various intracranial aneurysms including multiple aneurysms and giant aneurysms. ⋯ The keyhole approaches, based on improvements in diagnostic imaging, advanced surgical instruments, and microsurgical skills, are effective and ideal craniotomy techniques in the hands of experienced neurosurgeons for the treatment of intracranial aneurysms, including multiple and giant aneurysms, in patients without diffuse SAH, severe cerebral vasospasm, and severe brain edema or brain swelling.
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Controlled Clinical Trial
Magnesium sulfate: role as possible attenuating factor in vasospasm morbidity.
Among the many complications of SAH, one of the most important is vasospasm. Several treatment alternatives have been proposed for this condition, with far-from-ideal results being obtained. Magnesium sulfate recently returned to the scene (with still unproven benefit) as an adjuvant in the treatment of vasospasm. ⋯ Magnesium did not seem to interfere in vasospasm frequency but apparently acted favorably in decreasing morbidity and length of hospital stay.
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Case Reports
Acute combination fracture of atlas and axis: "triple" anterior screw fixation in a 92-year-old man: technical note.
The combination of odontoid and bilateral transarticular C1-C2 anterior screw fixation is a recent addition in treating C1-type II odontoid fractures. When feasible, it ensures early maximal stability, even if it slightly reduces the mobility of C1-C2 complex. We report a case of combination atlas-type II odontoid fracture that occurred in a 92-year-old man. The instability was treated with odontoid screw fixation and anterior bilateral C1-C2 transarticular screw fixation in a single stage. The aim of the article is to describe the feasibility of "triple" anterior screw fixation in the presence of C1-type II odontoid fracture. ⋯ The authors suggest that in presence of C1-type II odontoid fracture, the triple anterior screw fixation has to be taken into account as salvage procedure, especially if other methods of stabilization failed or cannot be safely performed. This technique seems to be safety feasible also in old patients, as our report and the experience of others confirm.
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The present study was undertaken to evaluate 10% hydroxyethyl starch (HES 200/0.5) with regard to its clinical outcome and safety in the treatment of severe head injury. ⋯ The 10% HES (200/0.5) can be used in the treatment protocol of severe head injury. There is no definite bleeding complications documented by current dosage of HES. Besides, balanced fluid management can be achieved without causing serious pulmonary complications. However, a further randomized, prospective study is needed to define the actual benefit of HES in fluid management and clinical outcome.
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Hydrocephalus associated with intracranial germ cell tumors or disseminated medulloblastoma has been treated with ventriculoperitoneal shunt. However, this procedure has a potential risk of intraperitoneal metastasis of these brain tumors. To prevent this potential risk and to minimize the risk of infection, we developed a percutaneous long-tunneled ventricular drainage (PLTVD). To confirm the effectiveness, we retrospectively analyzed the results of this procedure. ⋯ Percutaneous long-tunneled ventricular drainage was an effective method to manage long-lasting obstructive or communicating hydrocephalus with germ cell tumors and medulloblastoma.