Neurosurgery
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A retrospective review of 373 adult patients admitted to Harbor General Hospital between 1980 and 1984 for minor closed head injury (Glasgow coma scale 13-15) was performed to determine the benefits of skull radiography, computed tomographic (CT) scanning of the head, and admission for observation. Variables reviewed were mental status, neurological examination, presence or absence of loss of consciousness, clinical evidence of basilar skull fracture, and fracture on skull radiography. The neurological examination (including mental status and Glasgow coma scale) in the emergency room was the best predictor of subsequent deterioration or the presence of an operative hematoma. ⋯ If no operative lesion is found on the CT scan, the patient should be admitted for observation because there is still a risk of deterioration. Those with a Glasgow coma scale score of 15, a normal mental status, and no hemispheric neurological deficit may be discharged to be observed at home by a competent observer despite basilar or calvarial skull fracture, loss of consciousness, or cranial nerve deficit. No benefit was gained from skull radiography in any group.
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Advances in microsurgical techniques combined with a widening interest in same-day surgery led us to investigate ambulatory lumbar discectomy. We could find no precedent in the literature. Ten patients with classic ruptured lumbar discs confirmed by computed tomography chose to participate. ⋯ All returned to their usual occupation between 3 and 14 days postoperatively. All were satisfied and would choose the outpatient program again. Our experience indicates that ambulatory lumbar microdiscectomy can be a safe, effective option for selected patients.
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Eight patients with atlantoaxial instability secondary to trauma or rheumatoid arthritis were treated with posterior C1-C2 arthrodesis using the Halifax interlaminar clamp and autogenous bone graft or methylmethacrylate. Thus far, with an average follow-up of 6 months, satisfactory stability has been achieved with no instrument failure.
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In a prospective study on the effect of shunting, 22 patients diagnosed as suffering from normal pressure hydrocephalus (NPH) were investigated by means of temporary external lumbar drainage (ELD). Five patients had to be excluded from the study because of complications of ELD or definitive shunting. ⋯ The value of external lumbar drainage in NPH is discussed on the basis of personal experience and data from the literature. It seems to be a safe and valuable tool for predicting the outcome of definitive shunting procedures.
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Classification of carotid-cavernous fistulas (CCFs) into the four types described by Barrow allows the surgeon to choose the optimal therapy for each patient. Type A patients have fast flow fistulas that are manifest by a direct connection between the internal carotid arterial siphon and the cavernous sinus through a single tear in the arterial wall. The best therapy is obliteration of the connection by a detachable balloon. ⋯ Type C are supplied by feeders from the external carotid only and can almost always be obliterated successfully by embolizing the external carotid artery (ECA) branches. There are 4 Type C cases in this series of 37 spontaneous CCFs. All occurred in patients less than 30 years of age and were shunts between the middle meningeal artery and the cavernous sinus.(ABSTRACT TRUNCATED AT 250 WORDS)