Neurosurgery
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To describe the results of deep brain stimulation of the ipsilateral posterior hypothalamus for the treatment of drug-resistant chronic cluster headaches (CHs). A technique for electrode placement is reported. ⋯ These preliminary results indicate a role for posterior hypothalamic stimulation, which was demonstrated to be safe and effective, in the treatment of drug-resistant chronic CHs. These data point to a central pathogenesis for chronic CHs.
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Improved clinical and economic outcomes for high-risk surgical procedures have been previously cited in support of regionalization. The goal of this study was to examine the effects of regionalization by analyzing the cost and outcome of craniotomy for tumors and to compare the findings in academic medical centers versus community-based hospitals. ⋯ High-volume regional medical centers are capable of providing services with improved mortality rates and fewer hospital days, although with adjusted costs slightly higher than those at low-volume hospitals.
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To describe a surgical technique for a minimally invasive transcortical transventricular amygdalohippocampectomy via the inferior temporal sulcus (ITS) using a stereotactic navigator. ⋯ Combined with the stereotactic navigation system, the ITS approach provides the least invasive amygdalohippocampectomy that preserves optic radiation. This approach seems beneficial especially in patients in whom the epileptic lesions are limited to the anterior mesial temporal lobe.
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Optimal treatment of elderly patients with Type II odontoid fractures is controversial. Suggestions vary between conservative management and different types of early surgery. Recent data confirm that early surgery may be warranted because conservative treatment has a high rate of failure in the elderly. ⋯ Outcome after anterior odontoid screw fixation is not affected by patient age. Slightly higher rates of medical complications did not reach statistical significance. Because conservative management of odontoid fractures in the elderly has a high rate of failure, anterior stabilization for Type II odontoid fractures can be recommended.
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Multilevel anterior decompressive procedures for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament may be associated with a high incidence of neurological morbidity, construct failure, and pseudoarthrosis. We theorized that laminectomy and stabilization of the cervical spine with lateral mass plates would obviate the disadvantages of anterior decompression, prevent the development of kyphotic deformity frequently seen after uninstrumented laminectomy, decompress the spinal cord, and produce neurological results equal or superior to those achieved by multilevel anterior procedures. ⋯ Multilevel laminectomy and instrumentation with lateral mass plates is associated with minimal morbidity, provides excellent decompression of the spinal cord (as visualized on MRI), produces immediate stability of the cervical spine, prevents kyphotic deformity, and precludes further development of spondylosis at fused levels. Neurological outcome is equal or superior to multilevel anterior procedures and prevents spinal deformity associated with laminoplasty or noninstrumented laminectomy.