Neurosurgery
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Comparative Study
Experience with computed tomographic angiography for the detection of intracranial aneurysms in the setting of acute subarachnoid hemorrhage.
To objectively compare computed tomographic angiography (CTA) with selective digital subtraction angiography (DSA) in the detection and anatomic definition of intracranial aneurysms, particularly in the setting of acute subarachnoid hemorrhage (SAH). ⋯ CTA is useful for rapid and relatively noninvasive detection of aneurysms in common locations, and the anatomic information provided in images showing positive results is at least equivalent to that provided by DSA. In cases of SAH in which the nonaugmented CT and CTA results indicate a clear source of bleeding and provide adequate anatomic detail, we think it is possible to forego DSA before urgent early aneurysm surgery. In all other cases, DSA is indicated.
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To provide a theoretical basis for the selection of the anode-cathode configuration in spinal cord stimulation for the management pain when one percutaneous epidural electrode or two electrodes in parallel are used. ⋯ The relative positions of cathodes and anodes and their distance from the spinal cord are the major determinants of dorsal column/dorsal root activation and paresthesia distribution. The large interpatient variability of the intraspinal geometry is the main cause of differences in paresthesia coverage among patients having optimally placed electrode(s). Changes of paresthesia coverage over time are more probable when multiple electrodes are used.
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Intimate to the application of lateral transtemporal approaches to the cranial base are the identification, manipulation, and/or the sacrifice of the venous anatomy of the inferolateral temporal lobe and the superior petrosal sinus and the transection of the tentorium. This study demonstrates the relationship and variability of the venous drainage of the lateral and inferior surfaces of the temporal lobe. ⋯ An understanding of the complexity and diversity of the venous drainage complexes and their configurations is necessary to avoid venous complications during lateral cranial base surgery.