Surg Neurol
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Surgery is the most effective means of eliminating or reducing seizures in cases of medically refractory epilepsy. As elective surgery, however, there is little tolerance for complications. We have reviewed the early operative experience of a single epilepsy surgeon to identify the presence or absence of a surgical learning curve. ⋯ There appears to be a surgical learning curve for epilepsy surgery involving complications associated with removal of medial temporal lobe structures, which lessen as the surgeon's experience increases.
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Although congenital afibrinogenemia can commonly present with hemorrhage from the umbilical cord at birth, or with spontaneous mucosal or intracranial hemorrhage in the neonatal period, life-threatening intracerebral hemorrhage in adults is infrequent. ⋯ Spontaneous intracerebral hemorrhage must be included in the differential diagnosis in patients with known afibrinogenemia presenting with symptoms suggesting raised intracranial pressure. Immediately after surgery, intracranial pressure monitoring of patients is mandatory to pick up further intracranial bleeding early. Fibrinogen replacement therapy is recommended before surgery, but its use as a long-term prophylaxis against hemorrhage should be weighed against the risk of thrombosis.