Surgical neurology international
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The authors sought to assess long-term efficacy, surgical morbidity, and postoperative quality of life in patients who have undergone dorsal root entry zone (DREZ) lesioning. ⋯ With appropriate patient selection, DREZ lesioning is an efficacious and durable procedure that can be performed with low morbidity and good patient outcomes.
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Metastatic Ewing's sarcoma to the central nervous system is an uncommon condition and debate concerning the true origin of its metastases is still up to date. To the best of our knowledge, only two cases of dural metastatic Ewing's sarcoma have been published in the English medical literature. We present an additional case in a 24-year-old female and discuss the pathogenesis of these unusual tumors with review of the relevant literature concerning their treatment and outcome. ⋯ Despite its rarity, metastatic Ewing's sarcoma must be considered in the differential diagnosis of extra-axial dural masses particularly meningiomas.
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Coagulation accomplished using bipolar forceps is common in neurosurgery. Control of thermal spread from the forceps tips into surrounding neural tissues is a persistent concern, as neural tissues are especially vulnerable to heat injury. The purpose of our investigation was to compare the efficacy of cooling mechanisms for four different bipolar forceps and to understand thermal spread when coagulating vessels on the spinal cord. ⋯ Bipolar forceps incorporating either heat-pipe embedded technology or SILVERGlide coating can effectively limit excessive thermal spread, thus decreasing potential injury to adjacent tissues when compared with standard stainless steel and titanium bipolar forceps. Of the two, heat-pipe embedded technology appeared safest, having better cooling efficiency at higher temperature.
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The ideal sedative-hypnotic drug would be a rapidly titratable intravenous agent with a high therapeutic index and minimal side effects. The current efforts to develop such agents are primarily focused on modifying the structures of existing drugs to improve their pharmacodynamic and pharmacokinetic properties. Drugs currently under development using this rational design approach include analogues of midazolam, propofol, and etomidate, such as remimazolam, PF0713, and cyclopropyl methoxycarbonyl-etomidate (MOC-etomidate), respectively. ⋯ Such high-throughput screening offers the potential for identifying completely novel classes of drugs. Anesthetic drug development is experiencing a resurgence of interest because there are new demands on our clinical practice that can be met, at least in part, with better agents. The goal of this review is to provide the reader with a glimpse of the novel anesthetic drugs and new developmental approaches that lie on the horizon.
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Occurrence of pneumonia challenges the medical management of patients who have undergone surgery for aneurysmal subarachnoid hemorrhage, and is associated with significant mortality and morbidity. There are very few studies evaluating the incidence and outcome of postoperative pneumonia in patients undergoing microsurgical clipping of ruptured intracranial aneurysms. The aim of this study was to determine the incidence, risk factors, and outcome of postoperative pneumonia in patients undergoing surgery for ruptured intracranial aneurysms. ⋯ There is a high incidence of postoperative pneumonia and mortality associated with pneumonia (27.2% and 9.7%, respectively in our study) in patients of ruptured intracranial aneurysms undergoing microsurgical clipping at our center, with Acinetobacter species being the predominant causative organism.