Surg Neurol
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Previous studies have reported that as many as 30% of resident and fellow applicants misrepresent their publication record on their residency and fellowship applications. To determine if neurologic surgery residency applicants were guilty of similar rates of misrepresentation, we reviewed the applications submitted to our institution in the year 2001-2002. ⋯ We confirmed that applicants who reported their names along with their published citations did so honestly and accurately. In our study, misrepresentation of published manuscripts among neurologic surgery residency applicants was rare when compared to candidates in other specialties.
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Accidental opening of the frontal sinuses during craniotomy can lead to various postoperative complications. We report a simple and reliable reconstruction method using no exogenous or autogenous material obtained from another site. ⋯ Packing of a small bone piece from the bone flap is a quick and reliable method to reconstruct the frontal sinus opened during craniotomy.
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Clinical Trial Controlled Clinical Trial
Ultra-early decompressive craniectomy for malignant middle cerebral artery infarction.
Early surgical decompressive craniectomy (less than 24 hours) for malignant middle cerebral artery infarction (MCA) provides life-saving benefits. Detection of the infarction territory with computed tomography (CT) scan is usually less sensitive and delayed than diffusion-weighted imaging (DWI) that is capable of defecting the infarction territory in as little as 5 minutes after onset. Based on the DWI and clinical neurologic evaluations, ultra-early (less than 6 hours) decompressive craniectomy for malignant MCA infarction may be very helpful in improving mortality and morbidity rates. ⋯ Patients who underwent decompressive surgery had better outcomes than patients who did not have the operation. Ultra-early intervention with decompressive craniectomy with ICP monitoring before neurologic conditions become worse may reduce the mortality rate, increase the conscious recovery rate, and improve neurologic sequels for malignant MCA infarction. DWI with clinical neurologic evaluation (NIHSS, hemiplegia, down-hill GCS) provides for early diagnosis and treatment of malignant MCA infarction. Anterior temporal lobectomy may further reduce intraoperative ICP and reduce mortality, especially when the infarction is at multiple arterial territories.
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Difficulties with the intraoperative monitoring of evoked responses sometimes occur because of displacement or dislodgment of the recording electrodes during surgery, especially if placed on nonshaved scalp. ⋯ This fixation method for subdermal needle electrodes on the scalp is safe, reliable, and convenient for intraoperative electrophysiological monitoring of evoked potentials, even if the scalp is not shaved.
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A computerized monitoring system was developed and utilized to evaluate the relationship between mean arterial pressure and intracranial pressure and its effect on cerebral perfusion pressure to determine how best to maximize cerebral perfusion pressure. ⋯ In most patients, most of the time, increasing mean arterial pressure did not worsen cerebral perfusion pressure.