World Neurosurg
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Neurosurgeons have been familiar with the idea that hypothermia is protective against various types of brain injuries, including traumatic brain injury (TBI). Recent randomized controlled trials, however, have failed to demonstrate the efficacy of therapeutic hypothermia (TH) in patients with TBI. On the other hand, TH becomes popular in the treatment of out-of-hospital cardiac arrest (OHCA) survivors, after randomized controlled trials have shown that survival rate and functional outcome is improved with the use of TH in selected patients. We believe that knowledge on the recent progress in TH for OHCA is useful for neurosurgeons, because feedback of information obtained in the treatment of OHCA may revitalize the interest in TH for neurosurgical disorders, particularly TBI. ⋯ Neurosurgeons and critical care medicine physicians pursue the same goal of rescuing the brain from the secondary injury despite the difference in etiology (focal trauma vs. global ischemia), with the presumption that earlier and faster implementation of TH will result in better outcome. Thoughtful application of knowledge and techniques obtained in OHCA to TBI under a rigorously controlled situation will make a small, but significant difference in the outcome of TBI victims.
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Comparative Study
Outcome following symptomatic cerebral vasospasm on presentation in aneurysmal subarachnoid hemorrhage: coiling vs. clipping.
Cerebral vasospasm complicates both surgical and endovascular treatment of ruptured aneurysms. The present study analyzes patients with presentation vasospasm (PVSP) treated in the acute setting and compares outcomes in those treated with surgical clipping versus endovascular coiling. ⋯ Outcome did not differ between aSAH patients treated in the presence of symptomatic vasospasm compared to those with subsequent vasospasm. The outcome of patients presenting with vasospasm was not influenced by the modality of aneurysm treatment. This suggests that both surgical and endovascular intervention for the treatment of ruptured aneurysms are equally valid options in the setting of existing symptomatic vasospasm.
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Our goal is to indicate the importance of combining intraoperative tractography with motor-evoked potential (MEP) monitoring for glioma surgery in motor eloquent areas. ⋯ We found that intraoperative tractography demonstrated the location of the CST more accurately than preoperative tractography. The results of the linear regression between distance and stimulation intensity were informative for guiding approaches to tumor remnants without impinging on the CST. The combination of intraoperative tractography and MEP monitoring can enhance the quality of surgery for gliomas in motor eloquent areas.
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Historical Article
Neurological surgery at the National Institutes of Health.
The Surgical Neurology Branch (SNB) in the intramural program of the National Institute of Neurological Disorders and Stroke at the National Institutes of Health has been a unique setting for academic neurosurgery for nearly 60 years. Every patient evaluated and treated in the SNB is enrolled in a clinical research protocol, which underscores a singular focus on advancing neurosurgical research and patient care. Since the inception of the SNB, this research effort has been driven by dedicated clinician-investigators and basic scientists including Maitland Baldwin, Igor Klatzo, John M. ⋯ Currently, SNB efforts are focused on central nervous system drug delivery, the natural history of familial tumor syndromes, functional neurosurgery, epilepsy, vasospasm, and development of chemotherapeutics for malignant glioma. Throughout its history, the SNB has also been dedicated to training neurosurgeon clinician-investigators; 23 previous fellows/staff have become chairs of their respective neurosurgical departments. Recently, the commitment to training future neurosurgeon clinician-investigators has been further defined with the development of a residency-training program in neurological surgery approved in 2010.
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Comparative Study
Canadian health care and neurosurgery: the good, the bad and the ugly.