Neurosurgery
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This article describes the professional lives of the founders of neurological surgery in Brazil as well as the Brazilian Society of Neurosurgery. The pioneers were Augusto Brandão Filho, the first general surgeon to perform brain surgery in Brazil, and José Ribe Portugal and Elyseu Paglioli, the founders of the first two neurosurgery schools in Brazil. The Brazilian Society of Neurosurgery was founded in Brussels, Belgium, on July 26, 1957, during the First International Congress of Neurological Surgery, at the initiative of José Ribe Portugal and José Geraldo Albernaz.
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Comparative Study
Endovascular treatment for poorest-grade subarachnoid hemorrhage in the acute stage: has the outcome been improved?
Patients with poor-grade subarachnoid hemorrhage (SAH) have been considered good candidates for endovascular treatment. The results of treatment of Grade V SAH, the poorest grade, however, have not been fully elucidated. ⋯ Endovascular treatment of the 22 World Federation of Neurosurgical Societies Grade V SAH patients improved their survival rate but not their favorable outcome rate in comparison with conservative treatment. Further accumulation of clinical data is essential to determine whether endovascular treatment can improve the functional outcome of those with GCS scores of 6 and whether there is no role for endovascular treatment in those with GCS scores of 4 or 5.
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To determine the incidence of long-term hardware-related complications of deep brain stimulation (DBS). ⋯ Long-term follow-up reveals that hardware-related complications occur in a significant number of patients. Factors that lead to such complications must be identified and addressed to maximize the important benefits of DBS therapy.
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Stereotactic radiosurgery has been used for patients with high-risk cavernous malformations of the brain. We performed radiosurgery for patients with symptomatic, imaging-confirmed hemorrhages for which resection was believed to be associated with high risk. This study examines the long-term hemorrhage rate after radiosurgery. ⋯ Radiosurgery confers a reduction in the risk of hemorrhage for high-risk cavernous malformations. Risk reduction, although in evidence during initial follow-up, is most pronounced after 2 years. Given the difficulty of identifying high-risk patients, treatment after one major hemorrhage should be considered in selected younger patients. Such a strategy warrants further investigation.
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Review Case Reports
Cerebellar hemorrhage after spinal surgery: report of two cases and literature review.
Cerebellar hemorrhage remote from the site of surgery may complicate neurosurgical procedures. We describe our experience with two cases of cerebellar hemorrhage after spinal surgery and review the three cases previously reported in the literature to determine whether these cases provide insight regarding the pathogenesis of remote cerebellar hemorrhage. ⋯ Cerebellar hemorrhage must be considered in patients with unexplained neurological deterioration after spinal surgery. Dural opening with loss of cerebrospinal fluid has occurred in every reported case of cerebellar hemorrhage complicating a spinal procedure, supporting the hypothesis that loss of cerebrospinal fluid is central to the pathogenesis of this condition. Because remote cerebellar hemorrhage can occur after procedures with the patient in the supine, sitting, and prone positions, patient positioning seems unlikely to play a causative role in its occurrence.