Neurosurgery
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A variety of factors may affect surgical outcome in patients with cervical spondylotic myelopathy. The aim of this study is to determine these factors on the basis of preoperative radiological and clinical data. ⋯ It can be concluded that age and abnormal cervical curvature predict less postoperative neurological improvement. The presence of preoperative high signal intensity within the spinal cord may also reflect less neurological improvement.
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Case Reports
The anterior subtemporal, medial transpetrosal approach to the upper basilar artery and ponto-mesencephalic junction.
To describe and anatomically analyze the amount of exposure provided by an anterior subtemporal, medial transpetrosal approach to access the upper third of the basilar artery, ventral mesencephalon, pons, and posterior cavernous sinus. ⋯ This approach combines the wide view of the subtemporal approach with the more proximal exposure afforded by a medial petrosectomy. The widened visualization of the ventral pons and mesencephalon minimizes cranial nerve morbidity, greatly facilitates dissection of low-lying aneurysms, and provides proximal basilar artery control that would otherwise be obscured by the petrous ridge.
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Biography Historical Article
Library: historical perspective. John Farquhar Fulton.
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Review Case Reports
Nontraumatic atlanto-occipital and atlantoaxial rotatory subluxation: case report.
Concomitant atlantoaxial and atlanto-occipital subluxation resulting from any cause is extremely rare. We have found only five previously reported cases and describe another, suggesting a treatment plan. ⋯ Disruption of the occipito-atlanto-axial complex can result from relatively minor head and neck infections and should be suspected in children with persisting neck pain and decreased neck movements. It may not be necessary to perform an occipitoaxial fusion to treat these patients, and a more limited fusion may be successful.
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One of the largest contemporary neurosurgical experiences with hypothermic circulatory arrest was analyzed for trends in patient selection and clinical variables affecting outcome. ⋯ Current indications for hypothermic circulatory arrest include only giant and complex posterior circulation aneurysms that cannot be treated using conventional techniques or that recur after endovascular coiling. Surgical morbidity and mortality rates reflect the increasing complexity of the aneurysms treated but are still more favorable than the natural history of these lesions. This experience demonstrates that management in specialized neurovascular centers can minimize the morbidity associated with circulatory arrest so that it remains a viable treatment option for complex posterior circulation aneurysms.