Neurosurgery
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The purpose of this study was to identify factors predictive of shunt-dependent hydrocephalus among patients with aneurysmal subarachnoid hemorrhage. The data can be used to predict which patients in this group have a high probability of requiring permanent cerebrospinal fluid diversion. ⋯ The results of this study can help identify patients with a high risk of developing shunt-dependent hydrocephalus. This may help neurosurgeons expedite treatment, may decrease the cost and length of hospital stays, and may result in improved outcomes.
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Recent neurosurgical literature reflects rapidly evolving, technically enhanced methods that promise to improve neurosurgical outcomes. We review our experience with computer image guidance, linear or sigmoid incisions after minimal shaving, and liquid wound dressing with 2-octyl cyanoacrylate (Dermabond; Ethicon, Inc., Somerville, NJ) for tumor craniotomy or craniectomy in our attempt to optimize craniotomy or craniectomy for tumor. ⋯ Modern neurosurgical techniques are beneficial for patients undergoing craniotomy or craniectomy for tumor and seem to be superior to standard techniques. Although the study is multifactorial and retrospective, this conclusion is further supported by the enhanced self-image patients have during the postoperative period.
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To analyze surgical results for the highly variable Spetzler-Martin Grade III arteriovenous malformations (AVMs), to demonstrate that outcomes vary among the different types of Grade III lesions, and to introduce a simple modification of the grading scale that might improve its usefulness for these AVMs. ⋯ Grade III AVMs are a heterogeneous group, with each type possessing different surgical risks, and the Spetzler-Martin grading scale should be modified accordingly. Grade III- AVMs (S1V1E1) have a surgical risk similar to that of low-grade AVMs and can be safely treated with microsurgical resection. Grade III+ AVMs (S2V0E1) have a surgical risk similar to that of high-grade AVMs and are best managed conservatively. Grade III AVMs (S2V1E0) have intermediate surgical risks and require judicious selection for surgery. Grade III* AVMs (S3V0E0) are either exceedingly rare, with a surgical risk that is unclear, or theoretical lesions with no clinical relevance.
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The effect of transluminal balloon angioplasty on cerebral biochemical monitoring during treatment of severe cerebral vasospasm after subarachnoid hemorrhage (SAH) was investigated. ⋯ Transluminal balloon angioplasty led to a continuous and effective resolution of cerebral vasospasm observed by sustained, improved cerebral biochemical parameters. Both P(ti)O(2) and lactate-to-pyruvate ratio might provide an early diagnosis of severe cerebral vasospasm after SAH and continuous surveillance of threatened tissue regions after transluminal balloon angioplasty.
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Biography Historical Article
Transcranial surgery for pituitary tumors performed by Sir Victor Horsley.
To describe the clinical details and the operative method used in pituitary tumors by Sir Victor Horsley (1857-1916), which represent the earliest attempts at pituitary surgery. ⋯ These cases provide insight into the presentation and operative treatment of pituitary tumors during the pre-Halsted era.