World Neurosurg
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The anatomic and biomechanical aspects of the L5-S1 level present unique operative challenges compared with the L4-L5 level. However, it has not been determined if self-reported outcomes and complications are different between patients treated with a minimally invasive transforaminal lumbar interbody fusion at these specific levels. ⋯ Despite differences in biomechanics and unique anatomic challenges at the L5-S1 interspace, there is no difference in self-reported outcomes for patients treated with minimally invasive transforaminal lumbar interbody fusion at the L4-L5 level compared with the L5-S1 level.
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To review the experience at a single institution with motor evoked potential (MEP) monitoring during intracranial aneurysm surgery to determine the incidence of unacceptable movement. ⋯ With the anesthetic and monitoring regimen, the authors were able to record MEPs of the upper and lower extremities in all patients and found only 3.2% demonstrated unacceptable movement. With a suitable anesthetic technique, MEP monitoring in the upper and lower extremities appears to be feasible in most patients and should not be withheld because of concern for movement during neurovascular surgery.
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Severe traumatic brain injury (TBI) is a dynamic neuropathologic process in which a substantial proportion of patients die within the first 48-hours. The assessment of injury severity and prognosis are of primary concern in the initial management of severe TBI. Supplemental testing that aids in the stratification of patients at high risk for deterioration may significantly improve posttraumatic management in the acute setting. ⋯ In conjunction with other clinical, physical, and radiologic evidence, blood-derived biochemical markers may serve to enhance prediction of early clinical trends after severe TBI.
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Case Reports
Normal saline injection via lumbar puncture for the treatment of acute tonsillar herniation: a report of 45 cases.
Current treatment of apnea attributable to acute tonsillar herniation often is inadequate. This study was undertaken to verify the clinical usefulness of normal saline injection via lumbar puncture for the treatment of apnea secondary to acute tonsillar herniation. ⋯ For patients with tonsillar hernia who did not regain spontaneous respiration after external ventricular drainage or removal of a supratentorial lesion, an aggressive approach may be considered. Injection of normal saline via lumbar puncture could improve outcome in some of these patients.
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To analyze the actual risk for patients with a patent foramen ovale (PFO) to experience a clinically relevant venous air embolism (VAE) during surgery performed in the semisitting position. ⋯ Under standardized anesthesia and neurosurgical protocols, patients with a PFO can be operated on safely in the semisitting position.