Neurosurgery
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The practice of neurosurgery at The University of Texas M. D. Anderson Cancer Center began in 1944 with one neurosurgeon among the 11 physicians present in a makeshift 16-room outpatient clinic at a temporary location. ⋯ D. Anderson is now one of the largest institutions in the world devoted exclusively to cancer patient care, research, education, and prevention, it has an unusual history, which is reviewed in terms of the institution's origin in 1941, its development under three presidents, and its fostering of neurosurgical oncology. We chronicle the growth and development of the department from 1990 to 2003 and describe the unique opportunities it presents for surgical innovation, for clinical and basic research, for training residents and fellows, and for multidisciplinary collaboration in neurosurgical oncology.
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Because it is difficult to predict the compaction of Guglielmi detachable coils (GDCs) after endovascular surgery for aneurysms, we studied the relationship between the coil packing ratio and compaction. Here, we propose a simple method for the preoperative estimation of coil compaction. Using follow-up angiograms, we studied the timing and degree of coil compaction in small terminal and side-wall aneurysms with narrow necks. ⋯ In patients who underwent embolization with GDC-10s of aneurysms that were small and had a small neck, the optimal coil packing ratio could be identified with the formula 0.3 x a x b x c. The probability of coil compaction was significantly higher when the coil packing ratio was less than 50%. To detect coil compaction after embolization, follow-up angiograms must be examined regularly for at least 12 months. To detect major coil compaction in patients with terminal type aneurysms, angiographic follow-up should not be shorter than 24 months.
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Anterior cervical discectomy is one of the most frequently performed surgical procedures of the cervical spine. ⋯ To the best of our knowledge, such a complication has not been described before in the English-language literature. We conclude that hemothorax is a rare, although serious, complication after anterior cervical discectomy and should be included in the differential diagnosis for patients with respiratory failure after an anterior cervical discectomy.
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Clinical features of aneurysms of the posterior cerebral artery: a 15-year experience with 21 cases.
To investigate the characteristic clinical behavior and develop guidelines for the clinical management of posterior cerebral artery aneurysms, we reviewed 21 cases treated during a 15-year period. ⋯ Posterior cerebral artery aneurysms have specific clinical characteristics compared with aneurysms located elsewhere. The aneurysmal site and size and the surgical technique did not significantly influence treatment outcomes.
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To compare the angles of approach and area of exposure to the anterior communicating artery (AComA) complex associated with pterional (PT), orbitopterional (OPT), and orbitozygomatic (OZ) craniotomies before and after gyrus rectus resection. ⋯ The vertical and horizontal angles of approach to the AComA complex are significantly larger for the OPT and OZ approaches compared with the PT approach. Use of the OZ approach may decrease the need for frontal lobe retraction and resection of the gyrus rectus.