Neurosurgery
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Review Case Reports
Fatal subarachnoid hemorrhage, with brainstem and cerebellar infarction, caused by Aspergillus infection after cerebral aneurysm surgery: case report.
Intracranial aspergillosis has been reported to cause subarachnoid hemorrhage (SAH) attributable to ruptured mycotic aneurysms. We describe a case of Aspergillus arteritis that caused SAH without aneurysm formation, followed by successive brainstem and cerebellar infarction. ⋯ When a patient presents with SAH of unknown origin followed by cerebral infarction, Aspergillus arteritis should be included in the differential diagnosis. Earlier recognition of this fungal infection improves the prognosis.
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Randomized Controlled Trial Clinical Trial
Evaluation of preoperative administration of the cyclooxygenase-2 inhibitor rofecoxib for the treatment of postoperative pain after lumbar disc surgery.
A combination of analgesics with different mechanisms of action may improve postoperative pain control and reduce the incidence of side effects. This study was designed to assess the efficacy of preoperative administration of rofecoxib (Vioxx; Merck & Co., Inc., Somerset, NJ) in reducing pain and opioid requirements after single-level lumbar microdiscectomy. ⋯ Preoperative rofecoxib is effective in reducing postoperative narcotic consumption in patients undergoing lumbar laminectomy. The use of rofecoxib does not shorten PACU length of stay or hospital discharge time. These outcome measures depend on multiple administrative factors.
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Review Case Reports
Ganglioglioma presenting as a meningioma: case report and review of the literature.
Gangliogliomas are intra-axial, avascular masses located predominantly in the temporal lobe. A ganglioglioma that mimics a meningioma in that it is extra-axial and has a significant extracranial vascular supply has not been reported previously. ⋯ This report confirms that gangliogliomas can present as extra-axial, vascular masses that are similar to meningiomas.
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Surgery in the superior frontal gyrus partially involving the supplementary motor area (SMA) may be followed by contralateral transient weakness and aphasia initially indistinguishable from damage to the primary motor cortex. However, recovery is different, and SMA deficits may resolve completely within days to weeks. No study has assessed the distinct postoperative deficits after tumor resection in the SMA on a homogeneous patient group. ⋯ Surgery for Grade II gliomas in the superior frontal gyrus is more likely to result in permanent morbidity when the resection is performed at a distance of less than 0.5 cm from the precentral gyrus or positive stimulation points. Therefore, cortical mapping of motor and speech function, in critical cases under local anesthesia with the patient as his or her own monitor, is recommended; resection should be tailored to obtain good functional outcome and maintain quality of life.
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Biography Historical Article
History of the Lahey Clinic department of neurosurgery.
THIS HISTORY OF one of the early departments of neurosurgery provides some perspective on the changing practice of this specialty during its formative years. Under the guidance of James L. Poppen and Gilbert Horrax, the Department of Neurosurgery at the Lahey Clinic assumed a prominent role in extending Harvey Cushing's methods, enlightened by Poppen's techniques, many of which were ahead of their time, and provided inspiration to the next generations of neurosurgeons. Although the pattern of neurosurgery has changed remarkably in the past 70 years, basic principles have remained much the same.