Neurosurgery
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Review Historical Article
Electrical bone graft stimulation for spinal fusion: a review.
Although electrical stimulation to aid bone fusion is well established in the treatment of long-bone fractures, its use as an aid in spinal fusion is not as well documented. This article presents the history and scientific basis of electrical stimulation to aid bone fusion and extensively reviews the clinical literature. It is intended to provide an objective review of the indications and limitations of electrical stimulation to enhance spinal fusion and to serve as a reference source for further study.
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Clinical Trial
The efficacy and cost of prophylactic and perioprocedural antibiotics in patients with external ventricular drains.
Prophylactic antibiotics are routinely administered to patients with external ventricular drains (EVDs); however, no conclusive evidence supports this practice. This study compared the efficacy and cost of prophylactic and periprocedural antibiotics in patients with EVDs. ⋯ Prophylactic antibiotics did not significantly reduce the rate of ventriculitis in patients with EVDs, and they may select for resistant organisms. Discontinuing the use of prophylactic antibiotics for EVDs at the authors' institution would save approximately $80,000 per year in direct drug costs.
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Case Reports
Parameters for contralateral approach to ophthalmic segment aneurysms of the internal carotid artery.
This study was undertaken to define more accurately the feasibility and indications of the contralateral pterional approach to ophthalmic segment aneurysms of the internal carotid artery (ICA). ⋯ Parameters A to D are important for assessing the feasibility of the contralateral approach to ICA-ophthalmic segment aneurysms, and Parameters E and F are most useful for calculating the difficulty of this approach.
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Modern neuronavigation systems lack spatial accuracy during ongoing surgical procedures because of increasing brain deformation, known as brain shift. Intraoperative magnetic resonance imaging was used for quantitative analysis and visualization of this phenomenon. ⋯ Without brain shift compensation, neuronavigation systems cannot be trusted at critical steps of the surgical procedure, e.g., identification of the deep tumor margin. Intraoperative imaging allows not only evaluation of and compensation for brain shift but also assessment of the quality of mathematical models that attempt to describe and compensate for brain shift.
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Multiple interstitial substances measured by microdialysis in patients with subarachnoid hemorrhage.
Intracerebral microdialysis is a tool to monitor metabolic disturbances in the brains of patients with severe head injuries or subarachnoid hemorrhage (SAH). In the search for putative indicators of primary and secondary brain damage, we measured multiple metabolites in the dialysates of patients with SAH, to elucidate their significance for the outcomes of the patients as well as their temporal profiles of liberation after the insult. ⋯ These data confirm the usefulness of excitatory amino acids and lactate as major parameters for neurochemical monitoring for patients threatened by acute cerebral disorders. Other substances, such as taurine and nitrite, were also demonstrated to be potentially predictive. Release of these substances into the extracellular fluid of the brain might be particularly relevant for the development of secondary brain damage after SAH, e.g., infarction or brain swelling.