Journal of neurosurgery
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Journal of neurosurgery · Oct 2002
Fibrinolysis therapy achieved with tissue plasminogen activator and aspiration of the liquefied clot after experimental intracerebral hemorrhage: rapid reduction in hematoma volume but intensification of delayed edema formation.
Fibrinolysis therapy accomplished using tissue plasminogen activator (tPA) and aspiration is considered to be a viable alternative to microsurgery and medical therapy for the treatment of deep-seated spontaneous intracerebral hematomas (SICHs). Tissue plasminogen activator is a mediator of thrombin- and ischemia-related delayed edema. Because both thrombin release and ischemia occur after SICH, the authors planned to investigate the effect of fibrinolytic therapy on hematoma and delayed edema volume. ⋯ Despite a significantly accelerated reduction in hematoma volume, the development of delayed perifocal edema was intensified by fibrinolytic therapy, which is probably related to the function of tPA as a mediator of edema formation after thrombin release and ischemia. Further experimental and clinical investigations are required to establish the future role of fibrinolysis in the management of SICH.
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Journal of neurosurgery · Oct 2002
Hydroxyapatite laminar spacers and titanium miniplates in cervical laminoplasty.
The authors describe a new surgical technique for cervical laminoplasty that was performed in 25 patients. The posterior elements along with the various ligaments are removed en bloc and are stabilized in a lift-up position by placing hydroxyapatite (HA) laminar spacers and titanium miniplates and screws. The procedure and clinical results are discussed. ⋯ This technique enables rigid laminoplasty while maintaining anatomical and biomechanical integrity of posterior elements of cervical spine. Expansive and nonexpansive laminoplasty procedures are possible.
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Journal of neurosurgery · Oct 2002
Case ReportsA bone and cable girth-hitch technique for atlantoaxial fusion in pediatric patients. Technical note.
A new technique for performing a posterior rib and multistranded cable atlantoaxial fusion in children is described. The technique has been used successfully, in two patients 22 and 18 months of age, respectively. In both cases, fusion was used to augment C1-2 transarticular screw fixation, and solid arthrodesis was achieved without a halo orthosis.
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Journal of neurosurgery · Oct 2002
Ophthalmological outcome after orbital entry during anterior and anterolateral skull base surgery.
Partial resection of the orbital bones is not uncommon during the excision of anterior and anterolateral skull base tumors. Controversy exists regarding the need for and extent of reconstruction after this procedure. The authors studied this factor in a series of patients. ⋯ In most patients elaborate orbital reconstruction is not necessary after partial excision of the orbital bones. Isolated medial and lateral orbital wall defects, or combined superior and lateral orbital wall defects, especially in cases in which the periorbita is intact, probably do not require primary reconstruction. In cases of orbital floor defects, whether isolated or part of a multiple-wall resection, primary reconstruction is recommended.
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Journal of neurosurgery · Oct 2002
Surgical treatment of spinal deformities associated with neurofibromatosis type 1. Report of 12 cases.
In 10 to 50% of cases with neurofibromatosis, skeletal disorders are present, mainly as various deformities of the spine. These deformities can be divided into dystrophic and nondystrophic groups depending on the absence or presence of bone dystrophy. The nondystrophic curves are highly similar to those in idiopathic scoliosis, whereas the dystrophic curves are manifested early and, by progressing inexorably, may lead to neurological symptoms. In this article the authors report on a series of 12 patients (11 with dystrophic and one with nondystrophic deformities) who underwent surgical treatment. ⋯ The surgical treatment of dystrophic curves always included 360 degrees fusion and the use of a tibial corticocancellous graft, which must be placed on the concave side of the curve in the frontal plane, the graft thereby providing biomechanical support.