Neurosurgery
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Comparative Study Clinical Trial
Stereotactic radiotherapy for vestibular schwannomas: favorable outcome with minimal toxicity.
To determine the outcome and toxicity in patients with vestibular schwannomas treated with conventionally fractionated stereotactic radiotherapy (SRT) and to identify prognostic factors that are predictive of outcome. ⋯ SRT in the conventionally fractionated approach results in a very favorable outcome with minimal toxicity, with results comparable to those of the best of the radiosurgery series. Patients with large tumors are more likely to undergo neurosurgical interventions after SRT. Patients who have undergone previous surgery are at increased risk of developing trigeminal neuropathy.
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Although the transsphenoidal approach is the preferred approach to the vast majority of pituitary tumors with or without suprasellar extension, the transcranial approach remains a vital part of the neurosurgical armamentarium for 1 to 4% of these tumors. The transcranial approach is effective when resection becomes necessary for a portion of a pituitary macroadenoma that is judged to be inaccessible from the transsphenoidal route because of isolation by a narrow waist at the diaphragma sellae, containment within the cavernous sinus lateral to the carotid artery, projection anteriorly onto the planum sphenoidale, or projection laterally into the middle fossa. ⋯ Because application of the transcranial approach to pituitary adenomas is and should be rare in clinical practice, it is useful to standardize the technique to a default mode with which the surgical team is most experienced and, therefore, most comfortable. Our default mode for transcranial pituitary surgery is the frontotemporal-orbitozygomatic approach.
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Comparative Study
Sensory and motor interhemispheric integration after section of different portions of the anterior corpus callosum in nonepileptic patients.
We evaluated somatosensory and motor interhemispheric integration in four patients who underwent transection of different portions of the anterior corpus callosum (CC) for removal of an intraventricular cyst. The study goal was to relate their performances to the topographical organization of the CC. ⋯ The specific disconnections deficits observed in this study may provide the surgeon with information regarding the consequences of anterior callosotomy and allow for remedial measures to be implemented if required.
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Comparative Study Clinical Trial
Management and outcomes of 42 surgical suprascapular nerve injuries and entrapments.
Retrospective chart reviews of 42 patients with surgical suprascapular nerve (SSN) injury/entrapment were performed. Presenting symptoms, findings, operative approach, and results are documented. ⋯ Although SSN injury/entrapment is rare, 42 patients are presented who responded well to SSN release. Supraspinatus muscle improvement was as good as or better than that achieved in the infraspinatus.
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Comparative Study Clinical Trial
Resorbable polylactic acid interbody spacers with vertebral autograft for anterior cervical discectomy and fusion.
Resorbable polylactic acid spinal implants have recently become commercially available. These spacers carry the advantages of allowing for clear visualization of new bone growth, eliminating the risk of pathogen transmission, and providing for consistent biomechanical quality. However, previously published reports on the use of these spacers have all utilized bone morphogenetic proteins to supplement the fusion. This report describes our early experience with the use of these devices for interbody reconstruction in anterior cervical discectomy with fusion. ⋯ Resorbable polylactic acid interbody spacers are safe and effective for anterior cervical discectomy and fusion. Use of locally harvested vertebral endplate bone packed within the spacer is sufficient to promote fusion in anterior cervical discectomy with fusion.