World Neurosurg
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To evaluate the cerebral and hemodynamic effects of low-dose intramuscular diclofenac sodium (DCFS) administered for fever control in patients with acute brain injury in the intensive care unit. ⋯ Low-dose intramuscular DCFS administration for fever control in patients with acute brain injury is effective but also exposes patients to potentially deleterious hypotensive episodes that must be diagnosed and treated expeditiously to prevent further damage to the injured brain.
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Therapeutic decompressive craniectomy (TDC) controls increased intracranial pressure (ICP). Its role was controversial until its successful introduction to treat malignant middle cerebral artery ischemia. However, standardization of size and site of TDC remains controversial. This study was designed to evaluate whether size and site matter in TDC. ⋯ The size of a TDC is very important in reducing increased ICP. The size should be tailored to the level of increased ICP and the likelihood of further brain swelling postoperatively. A smaller TDC should be located more anteriorly to control increased ICP. Although location is not as important when increased ICP is >30 mm Hg and TDC size ≥8.3 cm is required.
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To evaluate the microsurgical anatomy of the fiber tract connections of the supplementary motor area (SMA) and pre-SMA, and examine its potential functional role with reference to clinical trials in the literature. ⋯ The SMA complex has numerous connections throughout the cerebrum. An understanding of these connections is important for presurgical planning for lesions in the frontal lobe and helps explain symptoms related to SMA injury.
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To study the curative effect and prognosis of patients with basal ganglia cerebral hemorrhages treated using a transcortical-sulcus approach and compare with results obtained using the traditional cerebral cortex approach. ⋯ The transcortical-sulcus approach can significantly improve the prognosis of patients with intracerebral hemorrhages in the basal ganglia and reduce the incidence of postoperative seizures.
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Spinal syphilitic gumma is an unusual presentation of neurosyphilis, with a limited number of cases reported in the literature. Owing to its extreme rarity, the diagnosis and treatment of spinal syphilitic gumma and the relevant prognosis have not been outlined. ⋯ Spinal syphilitic gumma can occur in the intramedullary region, and clinicians should be aware of this extremely rare entity, as it can be easily mistaken for more common neoplasms occurring at this site. The magnetic resonance imaging appearance of this entity has some suggestive characteristics, and a confident diagnosis depends on the pathology. Surgical resection can help to relieve acute spinal cord compression, and systemic antibiotic treatment for syphilis should be emphasized for long-term control.