Surg Neurol
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Randomized Controlled Trial Comparative Study
A prospective randomized trial comparing the technique of spinal and general anesthesia for lumbar disk surgery: a study of 100 cases.
General anesthesia and regional anesthesia have both been shown to be suitable techniques for patients undergoing lower thoracic and lumbar spine surgery; however, GA is the most frequently used method. The purpose of this study was to conduct an acceptable RCT to compare the intraoperative parameters and postoperative outcome after SA and GA in patients undergoing elective lumbar disk surgery. ⋯ Contrary to previous studies, the findings of the present study revealed that SA has no advantages over GA. Moreover, it was showed that GA can reduce the related risks and complications in several aspects.
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The brain exhibits neuroplasticity, the capacity to be modifiable by experience. Over the last decade there has been an explosion of knowledge in the field of neuroplasticity. ⋯ An understanding of neuroplasticity is essential for the practicing neurosurgeon since a lot of the drugs neurosurgeons prescribe affect neuroplasticity and a lot of neurosurgical diseases will be treated by therapies which modulate plasticity. In this article we review fundamental concepts of neuroplasticity for the practicing neurosurgeon.
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With improvement in imaging, CVT is being diagnosed more frequently. Early diagnosis and rapid institution of remedial measures such as anticoagulation, anticonvulsants, hydration, and treatment of underlying abnormality will aid in salvaging life. ⋯ Blood-fluid level in CVT may be an early radiologic sign in the absence of any other imaging abnormality. The presence of this sign in the early stages warrants an aggressive treatment because this probably suggests a large bleed with raised capillary and venous pressures. The case is discussed in view of the unusual radiologic sign in CVT in the absence of anticoagulant therapy.
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The authors describe their surgical experience of a hydatid cyst in the brainstem, which is an unusual site. The cyst was internally decompressed and totally excised. Although the Dowling technique has been described to be the ideal method for removal of hydatid cysts, it may not be possible when the cyst is in a deep-seated, vital, and eloquent location. We report the use of internal decompression by aspiration followed by total excision as an alternative method when the cyst is located in vital areas of the brain. ⋯ Hydatid cyst is a benign lesion. Appropriate management is mandatory for reducing the morbidity. Although the Dowling technique with its modifications is appropriate for cerebral parenchymal surfacing or superficial hydatid cysts, in deep-seated cysts located in eloquent and vital areas such as the brainstem, management by internal decompression by aspiration followed by extirpation of the cyst wall, protecting the surrounding cisterns and CSF spaces, is an alternative option.