Neurosurgery
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To elucidate the effect of treatment timing on procedural clinical outcomes after aneurysmal subarachnoid hemorrhage (SAH) for patients treated by endosaccular coil embolization. ⋯ The interval between endovascular treatment and SAH did not affect periprocedural morbidity rates or 6-month outcomes. Coil embolization should therefore be performed as early as possible after aneurysmal SAH, to prevent aneurysmal rerupture.
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Case Reports
Transdural cauda equina incarceration after microsurgical lumbar discectomy: case report.
Complications usually occur when they are least expected. We present an unusual case of nerve entrapment after microsurgical discectomy. ⋯ All dural tears that occur during intraspinal surgery, even if they are small and the arachnoid is intact, should be closed with stitches or at a minimum with a patch of muscle or gelatin sponge with fibrin glue. Care should be taken to avoid increased intra-abdominal pressure during extubation. Excessive pain and progressive neurological dysfunction occurring shortly after microsurgical lumbar discectomy or any intraspinal procedure is indicative of possible hemorrhage with subsequent compression of nerve roots. The case reported here provides anecdotal evidence that this situation can also be caused by a herniation of cauda equina nerve roots through a small dural defect that was not evident during the initial operation.
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The late 19th century and early 20th century represent an era of significant progress and important discoveries. Explorers of unknown continents interacted with pioneers of neuroscience, including the founders of the neuron doctrine, which asserted that nerve tissue was composed of individual cells that were genetic, anatomic, functional, and trophic units. Fridtiof Nansen (1861-1930), an arctic explorer and a cofounder of the neuron doctrine, knew Sigmund Freud (1856-1939), a neuroscientist and the founder of psychoanalysis, as well as Harvey Cushing (1869-1939), the father of modern neurosurgery. This is an account of the evolution of the neuron doctrine at a time of great explorers and scientists, with insight into their common interests and interactions on scientific and social levels.
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To evaluate the effect of preoperative embolization of meningiomas on surgery and outcomes. ⋯ In this preliminary study, only complete embolization had an effect on blood loss. The value of preoperative embolization for all meningiomas must be reconsidered, especially in view of the high costs and risks of embolization.
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Biography Historical Article
Howard H. Hepburn and the development of skull tongs for cervical spine traction.
The first use of skull tongs for cervical spine traction is credited primarily to W. G. Crutchfield. ⋯ Hepburn attended a meeting of the British Medical Society in 1930, and he is thought to have discussed his tongs during the conference. Hepburn's work has received some attention previously; his original tongs were included in a 1973 Smithsonian Institute exhibit on cervical spine traction as an example of an early cranial traction device. However, his contributions are underappreciated in the neurosurgical community and deserve wider recognition.