Neurosurgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal cord stimulation electrode design: a prospective, randomized, controlled trial comparing percutaneous with laminectomy electrodes: part II-clinical outcomes.
Spinal cord stimulation, in use for more than 30 years, has evolved into an easily implemented technique involving percutaneous or laminectomy electrode placement. In a randomized comparison of four-contact percutaneous and four-contact insulated laminectomy electrodes placed at the same level in the dorsal, epidural midline, quantitative measures of stimulator performance revealed significant technical advantages for the laminectomy electrodes. Our prospective, randomized, controlled trial compares clinical results in these same patients. ⋯ Laminectomy electrode placement, although more invasive than percutaneous placement, yields significantly better clinical results in patients with failed back surgery syndrome at mean 1.9 years follow-up. In our small sample, however, the statistical significance of this advantage disappeared at mean 2.9 years follow-up.
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Review Case Reports Comparative Study
Intracranial epidural hematoma in newborn infants: clinical study of 15 cases.
Epidural hematoma (EDH) in newborn infants is rare. We have described the history of 15 newborns with EDH to provide a better understanding of this pathology. ⋯ This report highlights the clinicoradiological characteristics of newborn EDH, which occurs more frequently in newborns that experienced difficult delivery from a nulliparous mother. Surgery is not a rule; some patients can be managed with conservative treatment. The outcome is generally good.
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Brain metastases continue to be a major and growing challenge in oncology, but recent advances in surgery, radiosurgery, and chemotherapy have broadened the number of treatment options. Current approaches to the management of brain metastases focus on individualizing patient care based on factors including the Karnofsky Performance Status, the tumor histology, the number of metastases, and the status of the systemic disease. ⋯ Although there is no current standard treatment, some general guidelines are recommended for single metastases, oligometastases (two to three brain metastases), and multiple (four or more) brain metastases, and for new or recurrent disease. With advances in systemic therapy for cancer, the treatment of brain metastases is becoming an increasingly important determinant of the length of survival and quality of life for cancer patients.
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Comparative Study
Intracranial pressure response to induced hypertension: role of dynamic pressure autoregulation.
Induced hypertension is commonly used to improve cerebral perfusion, but this treatment may have the deleterious side effect of raising intracranial pressure (ICP). We tested the hypothesis that dynamic pressure autoregulation testing could identify patients who might develop increased ICP during induced hypertension. ⋯ The patients who had an increase in ICP with induced hypertension had a greater degree of impairment of autoregulation and induced hypertension resulted in a greater increase in flow velocity.
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The past decade has been marked by significant improvements in the survival of patients with metastatic brain tumors, but the management of this disease presents a continuing challenge because of the varied nature of brain metastases and the limited survival time. Brain metastases are becoming more prevalent because of improvements in the treatment of extracranial lesions; this paradox brought together a seven-member multidisciplinary panel to discuss some of the most promising developments in imaging, surgical, and therapeutic techniques for metastatic brain tumors, and to address the perplexing challenges that remain. Their analyses are captured in this supplement, which begins here with an overview of metastatic brain cancer.