Journal of neurosurgery
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Journal of neurosurgery · Jan 2004
Comparative StudyPerformance of bipolar forceps during coagulation and its dependence on the tip material: a quantitative experimental assay. Technical note.
The aim of this study was to measure objectively the adherence of burned tissue to bipolar forceps to evaluate the coagulation performance of forceps made of different types of metals. Coagulation performance of bipolar forceps made of gold, titanium, and stainless steel was determined by comparing the amount of protein in the adhered coagulum on the tips. The amount of adhered coagulum was significantly less on the gold-plated bipolar forceps than on those made of the other two materials. ⋯ Histological examination of an artery coagulated with the gold-plated bipolar forceps showed that the structure had been completely collapsed without destruction of the layers, whereas arteries coagulated with the other materials revealed severely damaged structures. Adherence to bipolar forceps was dependent on both the material in the tips and the roughness of this material. The gold-plated bipolar forceps demonstrated the best performance.
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Journal of neurosurgery · Jan 2004
ReviewSurgical innovation or surgical evolution: an ethical and practical guide to handling novel neurosurgical procedures.
Surgical innovation is an important driver of improvements in technique and technology, which ultimately translates into improvements in patients' outcomes. Nevertheless, patients may face new risks of morbidity and mortality when surgical innovation is used, and well-intentioned surgical "experimentation" on patients must be regulated and monitored. In this paper the authors examine the challenges of defining surgical innovation and briefly review the literature on this challenging subject. ⋯ The authors propose guidelines for determining the need for regulation of innovation. The potential role of institutional review boards in this process is highlighted.
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Journal of neurosurgery · Jan 2004
Comparative StudyLaminoplasty for cervical myelopathy caused by subaxial lesions in rheumatoid arthritis.
Although controversy exists regarding surgical treatment for rheumatoid subaxial lesions, no detailed studies have been conducted to examine the efficacy of laminoplasty in such cases. To discuss indications for laminoplasty in rheumatoid subaxial lesions, the authors retrospectively investigated clinical and radiological outcomes in patients who underwent laminoplasty for subaxial lesions. ⋯ Patients with nonmutilating-type RA can benefit from laminoplasty for myelopathy due to subaxial lesions.
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Journal of neurosurgery · Jan 2004
Case ReportsImproved repair of cervical esophageal fistula complicating anterior spinal fusion: free omental flap compared with pectoralis major flap. Report of four cases.
Esophageal injury is a serious complication of anterior cervical fusion. A team approach to the management of these cases is described. The authors performed spinal assessment, control of the fistula, and interposition of a vascularized flap between the spine and the esophagus. They compared the overall efficacy of the pectoralis major flap (pedicled; two cases) and omental flap (free; two cases).