Neurosurgery
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Clinical Trial
Use of methylprednisolone as an adjunct in the management of patients with penetrating spinal cord injury: outcome analysis.
Since the results of the Second National Acute Spinal Cord Injury Study were published in 1990, methylprednisolone has become a mainstay in the treatment of nonpenetrating spinal cord injury. Although potential significant relationships between the prompt administration of high-dose methylprednisolone after blunt spinal cord injury and outcome have recently been addressed, the relationship between the prompt administration of high-dose methylprednisolone after penetrating spinal cord injury and outcome remain unanswered. ⋯ The administration of methylprednisolone did not significantly improve functional outcomes in patients with gunshot wound injuries to the spine or increase the number of complications experienced by patients during their hospitalizations.
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Case Reports
Embolization as treatment for spinal cord compression from renal cell carcinoma: case report.
Metastatic renal cell carcinoma may involve the vertebrae, resulting in acute spinal cord compression. Embolization has been used to reduce operative blood loss during surgical decompression, but it has not been considered as an alternative that may eliminate the need for open debulking. ⋯ This report illustrates that embolization may be used as palliative treatment for spinal cord compression and obviate the need for open surgical decompression.
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The mechanisms by which hypothermia influences postischemic outcome remain a matter of discussion. One mechanism thought to play an important role in neuronal damage after ischemia/reperfusion is the accumulation of polymorphonuclear leukocytes in compromised brain tissue. To better understand the potential impact of hypothermia on this injurious mechanism, the present study examined the effect of intraischemic hypothermia on polymorphonuclear leukocyte accumulation after transient focal ischemia. ⋯ These findings demonstrate that intraischemic hypothermia attenuates the inflammatory response to transient focal ischemia in the pericore region, i.e., the region spared from infarction under hypothermic conditions. The findings raise the possibility that a reduction in the inflammatory response after ischemia/reperfusion contributes to the neuroprotective effects of hypothermia.
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Review Case Reports
Intracerebral hemorrhage occurring remote from the craniotomy site.
The purpose of this study was to analyze the available clinical data on postoperative intracerebral hemorrhages that occur in locations remote from the sites of craniotomy. ⋯ Remote intracerebral hemorrhage is a rare complication of craniotomy with significant morbidity and mortality. Such hemorrhages likely develop at or soon after surgery, tend to occur preferentially in certain locations, and can be related to the craniotomy site, operative positioning, and nonspecific mechanical factors. They do not seem to be related to hypertension, coagulopathy, cerebrospinal fluid drainage, or underlying pathological abnormalities.
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We conducted a retrospective analysis of the clinical features of angiographically diagnosed unruptured intracranial aneurysms that were treated conservatively and subsequently ruptured. ⋯ We conclude that small unruptured intracranial aneurysms measuring less than 5 mm are susceptible to the risk of rupture, so that radical treatment or careful follow-up examination should be considered.