World Neurosurg
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Review Meta Analysis
How large is the typical subarachnoid hemorrhage? A review of current neurosurgical knowledge.
Despite the morbidity and mortality of subarachnoid hemorrhage (SAH), the average volume of a typical hemorrhage is not well defined. Animal models of SAH often do not accurately mimic the human disease process. ⋯ Based on our estimate of total SAH volume of 35 mL, animal injection models may now become standardized for more accurate portrayal of the human disease process.
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Review Historical Article
Surgery of the mind, mood, and conscious state: an idea in evolution.
Since the beginning of recorded history, humans have sought a physical means of altering disordered behavior and consciousness. This quest has spawned numerous innovations in neurosurgery and the neurosciences, from the earliest prehistoric attempts at trepanation to the electrocortical and anatomic localization of cerebral function that emerged in the 19th century. At the start of the 20th century, the overwhelming social impact of psychiatric illness intersected with the novel but imperfect understanding of frontal lobe function, establishing a decades-long venture into the modern origin of psychosurgery, the prefrontal lobotomy. ⋯ Recent decades have seen a revolution in minimalism, noninvasive imaging, and functional manipulation of the human cerebrum that have created new opportunities and treatment modalities for disorders of the human mind and mood. Early contemporary efforts were directed at focal lesioning of abnormal pathways, but deep-brain stimulation now aims to reversibly alter and modulate those neurologic activities responsible for not only psychiatric disorders, but also to modulate and even to augment consciousness, memory, and other elements of cerebral function. As new tools become available, the social and medical impact of psychosurgery promises to revolutionize not only neurosurgery, but also humans' capability for positively impacting life and society.
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Preoperative embolization of hypervascular head and neck tumors is frequently performed to reduce operative times and blood loss. While traditional transarterial embolization is commonly used, direct tumoral puncture has also been advocated as an alternative. We report our series of head and neck tumors embolized with onyx via direct tumoral puncture to ascertain the safety and efficacy of embolization using this technique. ⋯ Embolization of hypervascular head and neck tumors with onyx via direct tumoral puncture can be performed safely and efficiently. Tumor embolization by direct puncture may theoretically lower the risk of inadvertent migration of onyx through nontarget arterial vessels, but may increase the risk of inadvertent transtumoral embolization of venous structures. Caution should be exercised when using this technique for intracranial pathologies, and the importance of biplanar fluoroscopy to allow better visualization of the onyx migration cannot be overemphasized.
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Management of communicating hydrocephalus associated with infectious meningitis and arachnoiditis of the basal cisterns can be challenging if no microorganism or pathological diagnosis is established. The purpose of our series is to elucidate the efficacy of endoscopic basal cistern exploration, biopsy, and endoscopic third ventriculostomy (ETV) in patients with basal cistern meningitis and hydrocephalus. ⋯ Endoscopic transventricular basal cisterns exploration is feasible with a flexible neuroendoscope. It is a viable alternative in the management of patients with basal cistern meningitis and arachnoiditis without histopathological diagnosis. It yields to an accurate diagnosis in 79% of the patients. ETV is a good alternative in the management of intracisternal extraventricular obstructive hydrocephalus.
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To present the authors' experience in surgical treatment of patients with trigeminal neuralgia (TN) with intraneural vessels. ⋯ If the intraneural vessel is an artery, it can be decompressed by wrapping techniques. Otherwise, intraneural veins should be coagulated and divided. Most patients can achieve excellent or good pain relief with this approach; facial numbness is uncommon.