Neurosurgery
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Comparative Study Clinical Trial
Dual electrode thalamic deep brain stimulation for the treatment of posttraumatic and multiple sclerosis tremor.
To report the results of ventralis intermedius nucleus/ventralis oralis posterior nucleus (VIM) plus ventralis oralis anterior (VOA)/ventralis oralis posterior (VOP) thalamic deep brain stimulation (DBS) for the treatment of posttraumatic and multiple sclerosis tremor. ⋯ Tremors, such as those examined in this study, that are refractory to medications and have a poor response to VIM DBS monotherapy, may respond favorably to VIM plus VOA/VOP DBS. Two electrodes may be better than one for the treatment of certain disorders; however, more study will be required to confirm this hypothesis.
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To evaluate possible applications of microsurgical extirpation to arteriovenous malformations (AVMs) involving the brainstem. ⋯ Surgical resection can be applied with considerable, but acceptable, morbidity and mortality in some groups of brainstem AVMs with hemorrhagic presentation, particularly dorsal midbrain and cerebellopontine angle types, in which most parts of the nidus located sub- or extrapially.
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Comparative Study
Endovascular surgery for proximal posterior inferior cerebellar artery aneurysms: an analysis of Glasgow Outcome Score by Hunt-Hess grades.
Proximal posterior inferior cerebellar artery (PICA) aneurysms represent a subset of posterior circulation aneurysms that can be routinely treated with either clipping or coiling. The literature contains limited numbers of patients with proximal PICA aneurysms treated with endovascular surgery. We report our experience with endovascular surgery of proximal PICA aneurysms with emphasis on patients with poor Hunt-Hess grades. ⋯ This series demonstrates the safety and efficacy of endovascular surgery for proximal PICA aneurysms. Many patients with poor Hunt-Hess grades from ruptured PICA aneurysms ultimately had a good outcome. This could be secondary to early, aggressive treatment of hydrocephalus and the minimally invasive nature of the endovascular approach.
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Comparative Study Clinical Trial
The utility of intraoperative blood flow measurement during aneurysm surgery using an ultrasonic perivascular flow probe.
Inadvertent vessel compromise is one major cause of unfavorable outcome from aneurysm surgery. Existing strategies for intraoperative assessment of this complication have potential limitations and disadvantages. We assessed the utility of quantitative intraoperative flow measurements using the Transonic ultrasonic flow probe (Transonic Systems, Inc., Ithaca, NY) during aneurysm surgery. ⋯ Use of the ultrasonic flow probe provides real-time immediate feedback concerning vessel patency. Vessel compromise is easier to interpret than with Doppler, and faster/less invasive than intraoperative angiography. Intraoperative flow measurement is a valuable adjunct for enhancing the safety of aneurysm surgery.
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Comparative Study Clinical Trial
Single-stage thoracolumbar vertebrectomy with circumferential reconstruction and arthrodesis: surgical technique and results in 15 patients.
Circumferential reconstruction and arthrodesis can be necessary after thoracolumbar vertebrectomy. The authors describe a technique for single-stage thoracolumbar vertebrectomy with circumferential reconstruction and arthrodesis. The surgical results using this technique are reviewed. ⋯ The authors present a method for thoracolumbar vertebrectomy, circumferential reconstruction, and arthrodesis performed in a single stage, solely via a posterior approach. This is an alternative to anterior (i.e., thoracoabdominal and retroperitoneal) and lateral (i.e., lateral extracavitary) approaches that can be used for circumferential reconstruction and arthrodesis. Potential advantages and pitfalls are discussed.