Surg Neurol
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Lower back pain is extremely common; most patients' symptoms improve with conservative treatment. This leaves only a small percentage of patients with persistent symptoms that are amenable to surgery. Various decompressions have been performed to remedy compressive conditions of the spine, with a wide range of results. ⋯ We believe that less radical resection of laminae and spinous processes better preserves the spine's natural architecture and may contribute to improved postoperative stability. This may reduce the number of patients needing concomitant or subsequent fusion, with its associated morbidity. As surgeons push for less radical or less invasive surgical techniques to obtain the same or better postoperative results, the bilateral partial laminectomy is a good alternative to total laminectomy.
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We studied the change of brain tissue oxygen pressure (PbrO2) value within 24 hours after trauma and during moderate hypothermia in patients with severe head injury. The PbrO2 value was used to differentiate patients at risk of brain ischemia and to predict outcome. ⋯ The PbrO2 values were low in severe head injury, but hypothermia may improve these values. The technique of continuously monitoring brain tissue oxygen pressure may give better insight into cerebral oxygenation and warn of impending ischemia of brain tissue, especially in patients treated with hyperventilation. It will help to improve the management and final outcome of patients with severe head injuries.
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The expectation of monetary compensation has been associated with poor outcomes in lumbar discectomy, fueling a reluctance among surgeons to treat worker's compensation cases. This issue, however, has not been investigated in patients undergoing cervical disc surgery. This study analyzes the relationship between economic forms of secondary gain and surgical outcome in a group of patients with common pay scales, retirement plans, and disability programs. ⋯ Secondary gain in the form of economic compensation influences outcome in lumbar but not cervical disc surgery; this observation may in part account for the success of cervical surgery relative to lumbar discectomy. Social factors that are independent of the anticipation of economic compensation seem to influence the outcome of cervical disc surgery.
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Case Reports
An adult case of recurrent arteriovenous malformation after "complete" surgical excision: a case report.
Complete surgical excision of arteriovenous malformations (AVM) documented by postoperative angiography is considered a cure. However, recent reports have shown that AVMs in children may recur after negative postoperative angiograms, and some suggest that it may reflect the immaturity of their cerebrovasculature. This case report demonstrates that AVM in adults may also recur, despite postoperative angiograms confirming complete removal. ⋯ This is the oldest patient reported in the literature with a recurrence of AVM, despite postoperative angiograms confirming complete removal. Angiographically invisible immature vessels, which might have been left in the surgical field, might have formed a new malformation later. We still believe that such recurrence must be very rare after AVM surgery, but we now recommend follow-up angiography at yearly intervals to our patients.
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Despite advances in neuroimaging and neurosurgical treatment, spinal epidural abscess remains a challenging problem; early diagnosis is often difficult and treatment is delayed. Optimal management is unclear, and morbidity and mortality are significant. To define contemporary trends in etiology and management, and establish diagnostic and therapeutic guidelines, we reviewed our 10-year experience with spinal epidural abscess. ⋯ The frequency of diagnosis of spinal epidural abscess is increasing. To prevent serious morbidity and mortality, early diagnosis is essential. Patients with localized back pain who are at risk for developing such abscesses or who have an increased erythrocyte sedimentation rate and/or neurologic deficit should have an immediate MRI scan with contrast enhancement. Surgical drainage and prolonged antibiotic use are the cornerstones of treatment, although selected patients may be treated conservatively.