Neurosurgery
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Review Meta Analysis Comparative Study
Racial differences in cerebral vasospasm: a systematic review of the literature.
Despite a significant body of clinical research and the widespread use of early intervention with aggressive postoperative management, cerebral vasospasm (CV) continues to contribute significantly to the morbidity and mortality of aneurysmal subarachnoid hemorrhage (aSAH). Many studies have evaluated predictive factors, although none to date has investigated a possible difference in the incidence of CV between Asian and white patients. We present a review of the modern aSAH literature to examine the incidence of CV in Japan and Europe, two highly researched populations. ⋯ Patients in Japanese studies were more likely to experience CV after aSAH across diagnostic methods. This may be a manifestation of genetic differences between Japanese and European populations. Clinicians should consider possible patient differences when interpreting CV research conducted in these populations.
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A major concern in surgery is the prevention or control of bleeding. The ligature and the clip are the hallmarks of the last century of modern surgery. Therapeutic embolization is not really used to stop hemorrhage but to treat aneurysms and so prevent future rupture and bleeding. ⋯ Unfortunately, there are few areas in the central nervous system where such pressure can be applied, although it is a considerable help in opening muscle layers where self-retaining retractors will be used. Low-pressure venous bleeding may be controlled by application of gelfoam, surgically, or a bit of crushed muscle supported temporarily by a wet cottonoid pledget without occlusion of the venous channel. Historically, hot actual cautery or boiling oil were used to achieve hemostasis by forming a large tissue coagulum, which usually prevented bleeding until the entire dead mass sloughed away.
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Comparative Study Clinical Trial
Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope.
Percutaneous endoscopic transforaminal discectomy is often used as a minimally invasive procedure for lumbar disc herniation. However, a transforaminal approach posts limitations at the L5-S1 level owing to anatomic constraints, such as a high iliac crest or small intervertebral foramen and especially for migrated large intracanalicular disc herniations. We discuss the procedure and clinical results of percutaneous endoscopic interlaminar discectomy using a rigid working channel endoscope at the L5-S1 level and the relevant surgical anatomy. ⋯ Percutaneous endoscopic interlaminar discectomy is a safe, effective, and minimally invasive procedure for the treatment of intracanalicular disc herniations at the L5-S1 level in properly selected cases, especially when the transforaminal approach is not possible because of anatomic constraints.
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Comparative Study
Management of vestibular schwannomas that enlarge after stereotactic radiosurgery: treatment recommendations based on a 15 year experience.
Stereotactic radiosurgery is an effective alternative to surgical resection for the majority of patients with vestibular schwannomas (VS). However, after radiosurgery, the imaging characteristics of VSs are variable, and correct interpretation is critical to prevent unnecessary surgery for these patients. ⋯ Tumor expansion after VS radiosurgery rarely denotes a failed procedure, and the majority of patients only require further imaging. Approximately one third of tumors that enlarge will remain increased in size compared with the time of radiosurgery but will not show sequential growth. Additional tumor treatment should be reserved only for patients who demonstrate progressive tumor enlargement on serial imaging (2% in this series).
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We describe our surgical technique of exposure, control, and transposition of the third segment of the vertebral artery (VA V3 segment). ⋯ Perfect knowledge of the anatomy and the surgical technique permits a safe exposure, control, and transposition of the VA V3 segment. This is the first step of many surgical procedures.