Neurosurgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial.
Persistent or recurrent radicular pain after lumbosacral spine surgery is often associated with nerve root compression and is treated by repeated operation or, as a last resort, by spinal cord stimulation (SCS). We conducted a prospective, randomized, controlled trial to test our hypothesis that SCS is more likely than reoperation to result in a successful outcome by standard measures of pain relief and treatment outcome, including subsequent use of health care resources. ⋯ SCS is more effective than reoperation as a treatment for persistent radicular pain after lumbosacral spine surgery, and in the great majority of patients, it obviates the need for reoperation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: a prospective randomized study.
The authors report the results of a clinical series of selected patients with severe cubital tunnel syndrome. The degree of ulnar nerve compression was evaluated by use of a grading system that includes measurements of motor and sensitive function. The submuscular transposition with flexor-pronator mass Z lengthening was compared with simple decompression through a prospective randomized study. ⋯ No statistically significant difference was found between the two groups with regard to the clinical or the electrophysiological outcome. The surgical treatment gains in Group A and B were 80% and 82.86%, respectively (good to excellent results).
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Randomized Controlled Trial Comparative Study
Waterjet dissection versus ultrasonic aspiration in epilepsy surgery.
Waterjet dissection is currently under close investigation in neurosurgery. Experimentally, precise brain parenchyma dissection with vessel preservation has been demonstrated. Clinically, the safety of the instrument has already been proved. However, precise data demonstrating that waterjet dissection indeed reduces surgical blood loss are still missing. ⋯ The waterjet dissector enables a significant reduction of intraoperative blood loss in the investigated setting. However, further studies are needed to confirm these results with a larger number of patients. Studies also are needed to prove that the reduction of blood loss is of clinical relevance for the outcome of the patients.
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Comparative Study
The cut flow index: an intraoperative predictor of the success of extracranial-intracranial bypass for occlusive cerebrovascular disease.
There has been a resurgence of interest in selective extracranial-intracranial bypass for revascularization of cerebrovascular occlusive disease. We evaluated the usefulness of intraoperative blood flow measurements in predicting graft success after extracranial-intracranial bypass. ⋯ A poor CFI can alert surgeons to potential difficulties with the donor vessel, anastomosis, or recipient vessel during surgery. Furthermore, a CFI closely approximating 1.0 provides physiological confirmation of impaired cerebrovascular reserve in the recipient bed.
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Comparative Study
Cortical surface tracking using a stereoscopic operating microscope.
To measure and compensate for soft tissue deformation during image-guided neurosurgery, we have developed a novel approach to estimate the three-dimensional (3-D) topology of the cortical surface and track its motion over time. ⋯ We have demonstrated that a stereo vision system coupled to the operating microscope can be used to efficiently estimate the dynamic topology of the cortical surface during surgery. The 3-D surface can be coregistered to the preoperative image volume. This unique intraoperative imaging technique expands the capability of the current navigational system in the operating room and increases the accuracy of anatomic correspondence with preoperative images through compensation for brain deformation.