World Neurosurg
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Review Biography Historical Article
The History of Neurosurgery in the Hawaiian Islands.
The field of neurosurgery has a rich and fascinating history. The development of the specialty in Hawaii has been particularly unique, given the state's remote location, indigenous population, and military presence. The life of Dr. ⋯ This article will review and chronicle the development of neurosurgery in Hawaii with special attention to 3 topics: the traveling neurosurgeons of the early 20th century, such as Dr. Frederick Reichert; Hawaii's first full time neurosurgeon, Dr. Cloward; and finally, the current state of neurosurgery in Hawaii.
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Commercially available fibrin glue (Com-FG), which is used commonly worldwide, is produced with pooled human plasma from multiple donors. However, it has added bovine aprotinin, which involves the risk of infection, allogenic immunity, and allergic reactions. We evaluate the efficacy, reliability, and safety of completely autologous fibrin glue (CAFG). ⋯ CAFG effectively provides hemostatic, adhesive, and safety performance. The timing and three-dimensional shape of CAFG-soaked oxidized regenerated cellulose and/or polyglycolic acid sheets solidification can be controlled with slow fibrin formation. The cost to prepare CAFG is similar compared with Com-FG products, and it can therefore be easily used at most institutions.
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Comparative Study
Comparison of Recanalization and In-stent Stenosis between LVIS stent and Enterprise stent-assisted coiling for 254 intracranial aneurysms.
To compare the rates of recanalization and in-stent stenosis between the Enterprise (EP) and low-profile visualized intraluminal support (LVIS) stent deployments for intracranial aneurysms (IAs), and the factors associated therein. ⋯ Our data show acceptable rates of complete and near-complete occlusion with both the LVIS and EP stents. LVIS stents were associated with lower rates of recanalization and in-stent stenosis, but the difference was not significant. Higher SR (≥2) was a significant predictor of recanalization in IAs treated with EP stents, but not in those treated with LVIS stents.
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An inflammatory response occurs after aneurysmal subarachnoid hemorrhage (aSAH) and predicts poor outcomes. Glucocorticoids suppress inflammation and promote fluid retention. Dexamethasone is often administered after aSAH for postoperative cerebral edema and refractory headache. Our objective was to examine the impact of dexamethasone use on functional outcomes and delayed cerebral ischemia (DCI) after aSAH. ⋯ Dexamethasone use after aSAH was associated with a reduction in poor functional outcomes at discharge but not DCI, controlling for predictors of dexamethasone use.
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Prediction of vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) remains imperfect and currently relies on clinical and radiographic characteristics. Whether early hemodynamic changes may refine risk stratification for delayed vasospasm (DV) after aSAH was analyzed. ⋯ Tmax and MTT on angiography within 48 hours of aneurysm rupture before treatment provide an early quantitative assessment in patients with aSAH and in this small study were predictive for the development of subsequent symptomatic DV. Early identification of patients with aSAH at greatest risk of DV may ameliorate clinical outcome through timely, selective implementation of aggressive prophylactic therapy to prevent the effects of DV.