World Neurosurg
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Case Reports
"Sentinel seizure" as a warning sign preceding fatal rupture of a giant middle cerebral artery aneurysm.
Sentinel headache is a well-known warning sign preceding subarachnoid hemorrhage (SAH) caused by rupture of an intracranial aneurysm. New-onset seizure or "sentinel seizure" preceding aneurysmal SAH, however, is uncommon. ⋯ As with sentinel headache, new-onset seizures in patients with unruptured intracranial aneurysms might prompt immediate treatment to prevent imminent SAH with its subsequent high morbidity and mortality.
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A 40-year-old man was referred to our center with a 4-month history of progressive quadriparesis. Previous brain imaging revealed no abnormality. Magnetic resonance imaging (MRI) with contrast of the cervicothoracic spine revealed 2 heterogeneously enhancing lesions at the level of C3-C5 and T2-T4 (A); T1- and T2-weighted MRI showed hypointense and hyperintense lesions, respectively, which is characteristic of spinal cord astrocytoma (B and C). ⋯ Though resection was attempted, surgery was aborted due to hemodynamic instability and signal changes in neuromonitoring. The patient stabilized in the intensive care unit and experienced slight improvement in upper extremity strength. After discharge without further complications, the patient was expected to return for further adjuvant therapy/surgical planning but unfortunately passed away 1.5 months after his operation, most likely to rapid disease progression.
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To define the maxillary artery (MaxA) anatomy and present a novel technique for exposing and preparing this vessel as a bypass donor. ⋯ The MaxA can be exposed without zygomatic osteotomies or resection of the middle fossa floor. Anatomic landmarks for exposing the MaxA include the anterior and posterior deep temporal arteries and the pterygomaxillary fissure.
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To investigate the efficacy of antibiotic prophylaxis (AP) and the risk factors for postoperative infections in clean neurosurgery. ⋯ Our results show that in our data set, AP had no preventive effect on postoperative infections in clean neurosurgery. In addition, AP appeared to decrease the positive bacterial culture rate and to promote the emergence of multidrug-resistant bacteria. Cerebrospinal fluid leakage and surgery time were the risk factors for postoperative infection.
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Randomized Controlled Trial Comparative Study
Comparative study of two skin incisions for microscopic lumbar discectomy.
Microscopic lumbar discectomy is a common minimally invasive surgery. A transverse skin incision has sound theoretical cosmetic advantages compared with the classic vertical incision. We compared transverse and vertical skin incisions for microscopic discectomy regarding cosmetic outcome, postoperative pain, and the provided surgical cutaneous inlet. ⋯ Transverse skin incision for microscopic lumbar discectomy is an applicable alternative to classic midline or paramedian vertical incision with better esthetic results.