Journal of neurosurgery
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Journal of neurosurgery · Mar 2013
Case ReportsHemorrhagic colloid cyst with intraventricular extension.
Colloid cysts of the third ventricle presenting with acute obstructive hydrocephalus due to intracystic and intraventricular hemorrhage are extremely rare. The authors report a case of a 43-year-old man with a hemorrhagic colloid cyst that was treated using endoscopic surgery. A small colloid cyst of the third ventricle was initially diagnosed in the patient, and he was treated conservatively at that time. ⋯ Only partial removal of the cyst was performed because of a tough cyst wall with highly viscous, hemorrhagic cystic contents. Histological examination revealed a typical colloid cyst wall and hemorrhage mixed within a mucinous substance. Postoperative serial neuroimaging demonstrated a gradual reduction in the residual cyst size and normalization in the lateral ventricle size.
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A positive correlation between outcomes and the volume of patients seen by a provider has been supported by numerous studies. Volume-outcome relationships (VORs) have been well documented in the setting of both neurosurgery and trauma care and have shaped regionalization policies to optimize patient outcomes. Several authors have also investigated the correlation between patient volume and cost of care, known as the volume-cost relationship (VCR), with mixed results. The purpose of the present study was to investigate VORs and VCRs in the treatment of common intracranial injuries by testing the hypotheses that outcomes suffer at small-volume centers and costs rise at large-volume centers. ⋯ A VOR exists in the treatment of neurotrauma, and a meaningful threshold for significantly improved mortality is 6 cases per year. Emergency and interfacility transport policies based on this threshold might improve national outcomes. Cost of care does not differ significantly with patient volume.
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Journal of neurosurgery · Mar 2013
Biography Historical ArticleThe role of Harvey Cushing and Walter Dandy in the evolution of modern neurosurgery in the Netherlands, illustrated by their correspondence.
The development of modern neurosurgery in the Netherlands, which took place in the 1920s, was highly influenced by the personal involvement of both Harvey Cushing and Walter Dandy, each in his own way. For the present article, the authors consulted the correspondence (kept at the Cushing/Whitney Medical Library in New Haven and the Alan Mason Chesney Medical Archives in Baltimore) of Cushing and Dandy with their Dutch disciples. The correspondence provides a unique inside view into the minds of both neurosurgical giants. ⋯ At the beginning of World War II, Oljenick had to flee the country, which concluded the direct line with the Cushing school in the Netherlands. After Dandy's death (1946), Verbeek continued practicing neurosurgery following his style and philosophy. By the time Verbeek died in 1958, the strong American influence on everyday practice of Dutch neurosurgeons had been established.
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Journal of neurosurgery · Mar 2013
Outcome after transfer of intercostal nerves to the nerve of triceps long head in 25 adult patients with total brachial plexus root avulsion injury.
The intercostal nerves (ICNs) have been used to repair the triceps branch in some organizations in the world, but the reported results differ significantly. The effect of this procedure requires evaluation. Thus, this study aimed to evaluate the outcome of ICN transfer to the nerve of the long head of the triceps muscle and to determine the factors affecting the outcome of this procedure. ⋯ The transfer of ICNs to the nerve of long head of the triceps is an effective procedure for treating global brachial plexus avulsion injuries, even if combined with phrenic nerve transfer to the biceps branch. Two ICNs appear to be sufficient for donation. The earlier the surgery is performed, the better are the results achieved.
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Journal of neurosurgery · Mar 2013
Nervus intermedius dysfunction following Gamma Knife surgery for vestibular schwannoma.
The purpose of this study was to evaluate the function of the nervus intermedius, the nonmotor component of the facial nerve, following modern Gamma Knife surgery (GKS) for the treatment of vestibular schwannoma. ⋯ The authors demonstrated that 22% of patients undergoing modern GKS for vestibular schwannoma experience various disturbances of nonmotor components of the facial nerve as a result of the radiosurgery. Through this study, we can provide useful information about the likelihood of certain postradiosurgical symptoms for vestibular schwannoma.