Neurosurgery
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We report a series of 37 elderly patients who were surgically treated for intracranial meningioma in the ninth decade of life at our neurosurgical division between 1985 and 2002. ⋯ Surgical removal of a meningioma in the elderly is a safe procedure if the preoperative ASA classification is I or II and if the KPS rating is at least 70. Age seems not to be an insuperable obstacle when adequate management of all risk factors has been obtained.
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Randomized Controlled Trial Multicenter Study
Analysis of cost related to clinical and angiographic outcomes of aneurysm patients enrolled in the international subarachnoid aneurysm trial in a North American setting.
The goal of this study was to compare, in a North American setting, the cost-effectiveness of neurosurgical clipping versus endovascular coiling treatment of ruptured intracranial aneurysms. A secondary goal was to assess the clinical outcomes of patients enrolled into the International Subarachnoid Aneurysm Trial (ISAT) from the largest contributing North American center. ⋯ The high procedure costs of endovascular coiling tended to offset apparent reductions in length of stay. Long-term follow-up is indicated both for costs incurred after initial treatment and for clinical outcome in patients with incompletely obliterated aneurysms.
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Review Case Reports
Spontaneous spinal epidural hematoma during pregnancy: case report and literature review.
Spinal epidural hematoma is a rare cause of spinal cord compression and acute para- or quadriplegia. Traumatic spinal epidural hematomas are usually seen in older men with a history of ankylosing spondylitis and vertebral fracture. Spontaneous spinal epidural hematomas are commonly associated with coagulopathies, tumors, or vascular malformations. There have been only five previously published case reports in the English-language literature of spontaneous spinal epidural hematomas in conjunction with pregnancy. ⋯ The patient made a complete neurological recovery in long-term follow-up. In the meantime, she carried her pregnancy to term and gave birth to a healthy baby. Therefore, we advocate aggressive and early surgical intervention, similar to the five previously reported cases in the English-language literature, in the case of a spinal epidural hematoma causing cord compression and devastating neurological deficit in a pregnant woman.
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Historical Article
A fantastic voyage: a personal perspective on involvement in the development of modern stereotactic and functional neurosurgery (1974-2004).
Stressing environments, individuals, ideas, and global events, this historical stereotactic and functional neurosurgical vignette initially presents a review of factors in the genesis of personal interest and the foundations of involvement in the discipline of neurological surgery. The vignette then traces the development of concepts and instrumentation and their ultimate practical utilization in patient care on the neurosurgical services at the Keck School of Medicine at the University of Southern California over the course of a 3-decade period (1974-2004). The article summarizes and elaborates details of contributions to the literature and complex involvement on the national and international levels as the refinements and capabilities of stereotactic and functional neurosurgery have been reinvented over a generation through the emergence of new technology, ideas, individual ingenuity, and active collegial exchange.