Surg Neurol
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We report on a case of palatal myoclonus associated with olivary hypertrophy on magnetic resonance imaging (MRI) in a 63-year-old man. This rare radiological finding must be differentiated from a brainstem tumor.
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Implantable pumps for the delivery of intrathecal morphine have become a common option for administering opiate medication for the management of pain in patients with terminal cancer. Options for treating chronic pain of non-malignant origin are more controversial. This study describes responses to intrathecal morphine administration for managing chronic pain in patients without an underlying malignancy. ⋯ The morphine pump was found to be a viable alternative in the management of failed back syndrome. Its use in long-term therapy, however, is not without limitations and should be a last choice option.
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Indirect cerebral revascularization has been generally accepted in the management of brain ischemia in moyamoya disease. We performed indirect cerebral revascularization by using omental flap and muscle flap techniques for the treatment of ischemic cerebrovascular disease. ⋯ It is concluded that this method seems to be effective in selected patients with ischemic cerebrovascular disease.
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Reported outcomes in patients undergoing surgical procedures for lumbar disc herniation are poorer in patients eligible for workers' compensation or with pending litigation. In the civilian community, the amount of compensation for one's disability is variable and thus its influence on surgical outcome is difficult to quantify. In the military, all members are covered by a standardized workers' compensation system, and have generally standardized work requirements, a standard pay scale, and third party evaluation of disability based on the Veterans Affairs rating system. This made the military a good system in which to study the effect of potential compensation on surgical outcome. ⋯ Secondary gain in the form of disability pay has a proportionally adverse effect on outcome following lumbar disc surgery. Although studying this issue in the military system allowed standardization of secondary gain values, the influence of other factors could not be eliminated entirely. Potential disability pay is proportionally greater in lower ranked service members. Thus, other variables such as income level, education, and job satisfaction may contribute to the poorer results in this subgroup of military members.
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Spinal instrumentation has become an increasing part of the armamentarium of neurosurgery and neurosurgical training. For noncontroversial indications for spine fusion the arthrodesis rate seems to be better. For both noncontroversial and controversial indications, the reported complication rate with spinal instrumentation tends to be greater than that with noninstrumented spine surgeries. These reported complications include a 2-3% neurologic injury rate, 3-45% reoperation rate for implant failure, and inflection rates of 5-10%. Therefore, we report on 299 cases that have undergone spinal instrumentation placed exclusively by neurosurgeons with a very low complication rate. ⋯ The complication rate for using spinal instrumentation can be less than previously reported. Lessons learned and discussed should reduce the rate even more. Spinal instrumentation is a safe and useful adjunct to fusion in treating degenerative, traumatic, infectious, and neoplastic diseases of the spine.