World Neurosurg
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There has been a progressive decrease in the indications for cerebral revascularization during the past 30 years, particularly with the advance of endovascular techniques. Our objective was to define indications for and evaluate outcomes of patients treated with bypass surgery in the modern endovascular era. ⋯ Although microvascular cerebral revascularization is no longer performed as commonly as in the past, it remains an essential part of the skill set required to treat select vascular pathologies. Complex aneurysms are the single largest indication for direct bypass procedures. Moyamoya disease is by far the largest indication if indirect bypass procedures are included in the analysis. In experienced hands, the morbidity and mortality of patients undergoing cerebral revascularization procedures are low and long-term outcomes generally excellent.
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Bipolar coagulation has enhanced the capabilities and safety profile of contemporary neurosurgery and has become indispensable in the neurosurgical armamentarium. Nevertheless, significant heat transfer issues remain to be resolved before it can achieve the status of minimal risk. ⋯ These data suggest that the incorporation of the Ellman Surgitron Generator can result in the reduction of thermal transfer with conventional bipolar forceps compared with other generators. The combination with Codman ISOCOOL forceps can maximize the potential safety associated with bipolar coagulation. With regard to the use of comarketed pairs of forceps and generators, the combination of Ellman Surgitron Generator and Ellman bipolar forceps provided the best thermal profile.
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Comparative Study
Comparative effectiveness of frame-based, frameless, and intraoperative magnetic resonance imaging-guided brain biopsy techniques.
To compare the diagnostic yield and safety profiles of intraoperative magnetic resonance imaging (MRI)-guided needle brain biopsy with 2 traditional brain biopsy methods: frame-based and frameless stereotactic brain biopsy. ⋯ Frame-based, frameless stereotactic, and intraoperative MRI-guided brain needle biopsy techniques have comparable diagnostic yield for patients with no prior treatments (either radiation or surgery). Intraoperative MRI-guided brain biopsy is associated with fewer serious adverse events and shorter hospital stay.
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In Japan, idiopathic normal pressure hydrocephalus (iNPH) currently is treated mainly with lumboperitoneal (LP) shunts. Our aim was to evaluate whether LP shunting via the use of Medtronic Strata NSC programmable valves was as effective as ventriculoperitoneal shunting in the treatment of patients with iNPH from the perspectives of safety and symptomatic improvement rate. ⋯ LP shunts showed effectiveness rates that were similar to those of ventriculoperitoneal shunts. Despite the relatively high complication rate, LP shunts can be recommended for the treatment of patients with iNPH because of their minimal invasiveness and lack of lethal complications.
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Overlooking eye movement abnormalities associated with aneurysmal subarachnoid hemorrhage (aSAH) is common, although these abnormalities may greatly affect quality of life. Their prevalence remains undetermined. The aim of the study was to assess preoperative and postoperative eye movement abnormalities and their recovery in follow-up of patients with aSAH and their association with age, gender, and aSAH severity. ⋯ Eye movement abnormalities are a quite common finding in the acute stage of aSAH. Within 1 year, however, marked improvement occurs. Identifying these neuro-ophthalmic findings can assist in localization of the underlying pathology.