World Neurosurg
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Review Biography Historical Article
Music and Medicine: the tragic case of Gershwin's brain tumor and the challenges of Neurosurgery in the first half of the 20th century.
Although neurosurgery has gone through moments of great renewal in recent decades, at the beginning of the 20th century it was still dealing with the unfathomable mysteries of the nervous system and its disorders. Historical insight improves understanding of the great personalities of the past and allows us to look at the efforts of pioneering surgeons with greater awareness. ⋯ This article presents the tragic case of Gershwin's brain tumor. Through his story, it is possible to get an idea of the difficulties with which the great neuroscientists and surgeons of the past approached the human nervous system and its pathologic manifestations. The first part of this article deals with the evolution of Gershwin's disease over the years and the subsequent brain surgery. In the second part, general considerations on the most striking symptoms experienced by the composer are reported, as well as a description of the different hypotheses on the nature of Gershwin's tumor.
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To examine the literature on risk factors for cerebral vasospasm (CV), one of the most serious complications following aneurysmal subarachnoid hemorrhage (SAH), with special reference to the definition of CV. ⋯ Severe SAH evident on computed tomography scan appears to be a definite risk factor for CV after SAH, followed by cigarette smoking, hypertension, and left ventricular hypertrophy on electrocardiogram. To understand the pathogenesis of CV, further studies on the relationships between risk factors, especially factors not related to the severity of SAH, and angiographic vasospasm grade are necessary.
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Comparative Study
Minimally invasive transforaminal lumbar interbody fusion in multilevel; comparison with conventional transforaminal interbody fusion.
Minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) has shown superior or noninferior results compared with conventional TLIF in single segments. There were no comparative studies between MIS and conventional TLIF in multisegments. The purpose of this study was to compare MIS and conventional TLIF in multisegments. ⋯ MIS TLIF and conventional TLIF showed similar clinical and radiologic outcomes. MIS TLIF may be a better choice for 2- or 3-segment lumbar fusion in perioperative outcomes.
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Few reports have been published discussing surgical outcomes of paraclinoid aneurysms using multifarious treatments such as high-flow bypass. ⋯ Surgical treatment of unruptured paraclinoid aneurysm has high efficacy with good outcomes and a high rate of complete exclusion. However, the rate of visual disturbance is relatively high. Careful surgical techniques and intraoperative monitoring are therefore required.
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Comparative Study
Stereotactic Radiosurgery for Partially Resected Cerebral Arteriovenous Malformations.
Incomplete microsurgical resection of cerebral arteriovenous malformations (AVM) occurs uncommonly. However, such patients harboring postoperative residual nidi remain exposed to the risk of AVM hemorrhage and are therefore reasonable candidates for further intervention. The goals of this retrospective case-control study are to analyze the radiosurgery outcomes for partially resected AVMs and determine the effect of prior resection on AVM radiosurgery outcomes. ⋯ Radiosurgery affords a reasonable risk-to-benefit profile for incompletely resected AVMs. For those with a small-volume residual nidus after resection, radiosurgery should be considered an effective alternative to repeat resection.