Journal of neurosurgery
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Journal of neurosurgery · Mar 2004
ReviewSafety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review.
The purpose of this report was to examine the available literature to determine the safety and efficacy of spinal cord stimulation (SCS) for the treatment of chronic pain of the trunk and limbs. ⋯ Despite the positive findings, there is an urgent need for randomized, controlled, long-term studies on the efficacy of SCS involving larger patient sample sizes.
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Journal of neurosurgery · Mar 2004
Clinical TrialPoor-grade aneurysmal subarachnoid hemorrhage: relationship of cerebral metabolism to outcome.
The majority of patients with poor-grade subarachnoid hemorrhage (SAH), that is, World Federation of Neurosurgical Societies (WFNS) Grades IV and V, have high morbidity and mortality rates. The objective of this study was to investigate cerebral metabolism in patients with low- compared with high-grade SAH by using bedside microdialysis and to evaluate whether microdialysis parameters are of prognostic value for outcome in SAH. ⋯ Microdialysis parameters reflected the severity of SAH. The L/P ratio was the best metabolic independent prognostic marker of 12-month outcome. A better understanding of the causes of deranged cerebral metabolism may allow the discovery of therapeutic options to improve the prognosis, especially in patients with high-grade SAH, in the future.
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Journal of neurosurgery · Mar 2004
Clinical course of patients with ossification of the posterior longitudinal ligament: a minimum 10-year cohort study.
Ossification of the posterior longitudinal ligament (OPLL) may produce quadriplegia. The course of future neurological deterioration in patients with radiographic evidence of OPLL, however, is not known. The authors conducted a long-term follow-up cohort study of more than 10 years to clarify the clinical course of this disease progression. ⋯ Results of this long-term cohort study elucidated the clinical course of OPLL following conservative or surgical management. Surgery proved effective for the management of patients with Nurick Grades 3 and 4 myelopathy.
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Journal of neurosurgery · Mar 2004
Case ReportsRecurrent atlantoaxial rotatory fixation in children: a rare complication of a rare condition. Report of four cases.
Atlantoaxial rotatory fixation (AARF) is an uncommon condition of childhood. Occasionally AARF may recur. The authors describe the cases of four patients with recurrent AARF (RAARF). ⋯ In three cases, attempts were made to stabilize the atlantoaxial complex rather than to perform fusion to preserve the function of the joint complex. Joint stabilization is performed by incorporating a "check ligament" into the joint construct between the axial spinous process and the atlantal lateral mass. The authors believe this technique of joint stabilization augments the strength of the joint, allowing normal, but preventing excessive, rotation, until the joint reaches physiological maturity.
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Journal of neurosurgery · Mar 2004
Case ReportsGadolinium leakage into the surgical bed mimicking residual enhancement following spinal cord surgery. Case report.
Intramedullary spinal cord surgery can disrupt the blood-spinal cord barrier and cause intravascular contents to leak into the surgical cavity. Immediate postoperative Gd-enhanced magnetic resonance (MR) imaging can demonstrate leakage of contrast into the surgical bed and complicate the assessment of whether a residual enhancing tumor is present. ⋯ A Gd-enhanced MR imaging study obtained less than 24 hours after surgery revealed that the intramedullary surgical cavity was filled with contrast material. Because of the time course and the lesion's preoperative appearance, this "enhancement" was known to be caused by the leakage of medium into the resection cavity rather than of pathological soft-tissue enhancement.