World Neurosurg
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Case Reports Clinical Trial
Placement of percutaneous thoracic pedicle screws using neuronavigation.
Percutaneous thoracic pedicle screw fixation is challenging because of the complexity of the spinal anatomy and obscuration of normal surgical landmarks by soft tissue. We report a novel percutaneous technique in which intraoperative Iso-C C-arm navigation was used to treat complex thoracic spinal fractures. ⋯ Percutaneous thoracic pedicle screw fixation with intraoperative neuronavigation for the stabilization of complex spinal fractures is feasible and associated with acceptable rates of accuracy and morbidity.
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Randomized Controlled Trial
Applying cerebral hypothermia and brain oxygen monitoring in treating severe traumatic brain injury.
Severe traumatic brain injury (TBI) was to be one of the major health problems encountered in modern medicine and had an incalculable socioeconomic impact. The initial cerebral damage after acute brain injury is often exacerbated by postischemic hyperthermia and worsens the outcome. Hypothermia is one of the current therapies designed to combat this deleterious effect. The brain tissue oxygen (P(ti)o(2))-guided cerebral perfusion pressure (CPP) management was successfully reduced because of cerebral hypoxic episodes following TBI. ⋯ Therapeutic mild hypothermia combined with P(ti)o(2)-guided CPP/ICP management allows reducing elevated ICP before 24 hours after injury, and daily variations of ICP were shown to be significantly different among the three treatment groups after the third posttraumatic day. It means that the hypothermia groups may reduce the ICP earlier and inhibit the elicitation of acute inflammation after cerebral contusion. Our data also provided evidence that early treatment that lowers P(ti)o(2) may improve the outcome and seems the best medical treatment method in these three groups. We concluded that therapeutic mild hypothermia combined with P(ti)o(2)-guided CPP/ICP management provides beneficial effects when treating TBI, and a multicenter randomized trial needs to be undertaken.
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Comparative Study
Treatment of warfarin-related intracranial hemorrhage: a comparison of prothrombin complex concentrate and recombinant activated factor VII.
Warfarin-related intracranial hemorrhage (ICH) is a devastating complication of warfarin therapy. Several studies have demonstrated successful correction of the international normalized ratio (INR) using prothrombin complex concentrate (PCC) or recombinant activated factor VII (rFVIIa). To our knowledge, no study has directly compared these agents for treatment of warfarin-related ICH. ⋯ Correction of the INR is more reliably obtained with rFVIIa when compared to PCC. Larger, prospective studies comparing these therapies for warfarin-related ICH are needed.
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Comparative Study
Comparison of endoscopic transnasal and transoral approaches to the craniovertebral junction.
The study compared the endoscopic anatomy of the transnasal and transoral approaches to the craniovertebral junction (CVJ). ⋯ The endoscopic transoral and transnasal approaches to the CVJ should be viewed as complementary routes as opposed to strict alternatives.
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Clinical experience with a new surgical procedure called multiple hippocampal transections is described. In this procedure, seizure circuits within the hippocampus are disrupted by making multiple cuts parallel to the hippocampal digitations; while the vertical functional fibers are preserved. ⋯ This is a small series with a short follow-up period. However, the results are encouraging enough to warrant further trials. In addition, this may be an effective alternative procedure for those who fail the Wada test and do not have significant temporal lobe sclerosis or who have seizures originating from the dominant side.