Journal of neurosurgery
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Journal of neurosurgery · Jan 2002
Case ReportsCervicomedullary junction compression caused by vertebral artery dolichoectasia and requiring surgical treatment. Case report.
A case of progressive brainstem syndrome secondary to vertebral artery (VA) dolichoectasia is reported. The patient presented with partial bilateral abduction paralysis, which progressed to quadriparesis, ataxia, and areflexia. The initial diagnosis was stroke, but because of the patient's deterioration, a diagnosis of Miller-Fisher syndrome was made. ⋯ Follow-up imaging demonstrated worsened cervicomedullary compression. An emergency posterior fossa neurovascular decompression was performed using a Gore-Tex sling and resulted in mild neurological improvement. This case emphasizes that early recognition and surgical intervention to prevent progressive neurological sequelae are crucial in symptomatic VA dolichoectasia.
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Journal of neurosurgery · Jan 2002
Interactive stereoscopic virtual reality: a new tool for neurosurgical education. Technical note.
The goal of this study was to develop a new method for neurosurgical education based on interactive stereoscopic virtual reality (ISVR). Interactive stereoscopic virtual reality can be used to recreate the three-dimensional (3D) experience of neurosurgical approaches much more realistically than standard educational methods. The demonstration of complex 3D relationships is unrivaled and easily combined with interactive learning and multimedia capabilities. ⋯ The success of a neurosurgical approach is contingent on the mastery of complex, 3D anatomy. A new technology for neurosurgical education, ISVR can improve understanding and speed the learning process. It is an effective tool for neurosurgical education, bridging the substantial gap between textbooks and intraoperative training.
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Journal of neurosurgery · Jan 2002
A proposed radiosurgery-based grading system for arteriovenous malformations.
Radiosurgery is an effective treatment strategy for properly selected patients harboring arteriovenous malformations (AVMs). Grading scales that are currently used to predict patient outcomes after AVM resection are unreliable tools for the prediction of the results of AVM radiosurgery. ⋯ Despite significant differences in preoperative patient characteristics and dose prescription guidelines at the two centers, the proposed AVM grading system strongly correlated with patient outcomes after single-session radiosurgery for both patient groups. Although further testing of this model by independent centers using prospective methodology is still required, this system allows a more accurate prediction of outcomes from radiosurgery to guide choices between surgical and radiosurgical management for individual patients with AVMs.
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Journal of neurosurgery · Dec 2001
Case ReportsMetabolic acidosis, rhabdomyolysis, and cardiovascular collapse after prolonged propofol infusion.
The authors present the hospital course of a 13-year-old girl with a closed head injury who received a prolonged infusion of propofol for sedation and, subsequently, died as a result of severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse. The patient had been treated for 4 days at a referring hospital for a severe closed head injury sustained in a fall from a bicycle. During treatment for elevations of intracranial pressure, she received a continuous propofol infusion (100 microg/kg/min). ⋯ The patient died of myocardial collapse with severe metabolic acidosis and multisystem organ failure (involving renal, hepatic, and cardiac systems) approximately 15 hours after admission to the authors' institution. This patient represents another case of severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse observed after a prolonged propofol infusion in a pediatric patient. The authors suggest selection of other pharmacological agents for long-term sedation in pediatric patients.
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Journal of neurosurgery · Dec 2001
Biography Historical ArticlePioneers in the development of transsphenoidal surgery: Theodor Kocher, Oskar Hirsch, and Norman Dott.
The development of new scientific concepts and techniques is usually the result of a progressive evolution. The transsphenoidal approach to pituitary lesions is no exception. ⋯ In this historical vignette, the contributions of three master surgeons. Theodor Kocher, Oskar Hirsch, and Norman Dott, are reviewed.