Journal of neurosurgery
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Journal of neurosurgery · Jun 2007
Intracranial pressure and cerebral perfusion pressure as risk factors in children with traumatic brain injuries.
The authors evaluated the initial intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as prognostic factors in severe head injury in children and tried to determine the optimal CPP range. ⋯ Initial ICP and CPP measurements were useful as prognostic factors in pediatric patients with severe TBIs: patients with initial CPPs between 40 and 70 mm Hg were found to have a better neurological prognosis than those with CPPs either higher or lower than that range.
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Journal of neurosurgery · Jun 2007
Large ophthalmic segment aneurysms with anterior optic pathway compression: assessment of anatomical and visual outcomes after endosaccular coil therapy.
The optimal therapy for ophthalmic segment aneurysms with anterior optic pathway compression (AOPC) is undecided. Surgical results have been described, but the results of endovascular coil therapy have not been well documented. ⋯ The authors found that in patients with ophthalmic segment aneurysms causing chronic AOPC, endosaccular platinum coil therapy, with ICA preservation, may not benefit vision and that additional procedures may be needed. Evaluation of their results suggests that endovascular trapping of the aneurysm and sacrifice of the ICA appear to result in good visual, clinical, and anatomical outcomes.
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Selective dorsal rhizotomy (SDR) has been shown to provide considerable benefit to children with spastic cerebral palsy (CP). The authors sought to evaluate the risks of postoperative spinal deformities in patients following SDR. ⋯ There was a high rate of radiologically documented deformities in patients with CP who underwent SDR. Ambulatory function, CP severity, age at surgery, and sex may be contributing factors.
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Journal of neurosurgery · Jun 2007
Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003.
Neurosurgeons are a high-risk group for allegations of malpractice. To determine the kinds of cases and the neurosurgical practice patterns associated with the highest proportion of litigation, the authors examined the experience over a 5-year period of a major physician-owned and -administered insurance company dealing with this issue, the Medical Liability Mutual Insurance Company (MLMIC) of New York. With the MLMIC cases as a basis, the authors also analyzed areas of physician vulnerability and determined the steps neurosurgeons can take to reduce potential litigation. ⋯ A neurosurgeon's chances of being sued for malpractice are not necessarily related to the medical complexity of a particular case but rather to the types of cases with which the physician is involved. Elective spinal surgery cases constitute the majority of litigation. Neurosurgeons can take steps to reduce their vulnerability to potential litigation and to increase the odds of a successful defense.
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Journal of neurosurgery · Jun 2007
Case ReportsUse of 5-aminolevulinic acid in fluorescence-guided resection of meningioma with high risk of recurrence. Case report.
It has been established that fluorescence-guided resection using 5-aminolevulinic acid (5-ALA) is useful in glioma surgery. The authors report on a 65-year-old woman who had a huge atypical left-hemisphere meningioma, which extended into the skull and to the superior sagittal sinus and demonstrated fluorescence in response to administration of 5-ALA. ⋯ These remnants were completely removed. The authors concluded that fluorescence-guided resection using 5-ALA is useful in cases of atypical meningiomas with a high risk of recurrence.