Neurosurgery
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Complex tumors OF the glomus jugulare present a surgical challenge because of their difficult location, extreme vascularity, and involvement with multiple cranial nerves. Modern microneurosurgical and cranial base techniques have enabled safe total removal of these complicated tumors. We describe a one-stage transjugular posterior infratemporal fossa approach for radical resection of glomus jugulare tumors located around the jugular foramen, the lower clivus, and the high cervical region from an anterolateral direction. ⋯ Total exposure of the jugular foramen can be achieved, and multidirectional approaches can be performed, including infralabyrinthine/suprajugular, retrosigmoid/transcondylar/infrajugular, and transjugular exposures. Exposure of the vertical C7 segment of the infratemporal internal carotid artery and the lower clivus can be performed without permanent rerouting of the facial nerve. The details of this approach are described and illustrated in a stepwise fashion, and the microsurgical anatomy is reviewed.
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Stroke is a leading cause of morbidity and mortality in the United States. Recent animal studies have implicated the complement system in cerebral ischemia/reperfusion injury and suggest that complement inhibition may improve stroke outcomes. To assess the applicability of these findings to humans, we evaluated the characteristics and time course of human complement activation after stroke. ⋯ C3a is acutely elevated after human ischemic stroke, C5a shows delayed elevations 7 to 14 days after cerebral ischemia, and sC5b-9 is acutely depressed after stroke. Together, these data confirm complement activation after stroke and suggest that this activation is a heterogeneous process, with varying responses for different components.
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To evaluate incidence and risk factors of postoperative meningitis, with special emphasis on antibiotic prophylaxis, in a series of 6243 consecutive craniotomies. ⋯ Perioperative antibiotic prophylaxis, although clearly effective for the prevention of incision infections, does not prevent meningitis and tends to select prophylaxis resistant microorganisms.
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Several reports suggest that spine surgery has experienced rapid growth in the past decade. Limited data exist, however, documenting the increase in spinal fusion. The objective of this work was to quantify and characterize the contemporary practice of spinal fusion in the United States. ⋯ Cervical, thoracolumbar, and lumbar spinal fusion have experienced a rapid increase in utilization in isolation and compared with other surgical procedures in contemporary practice. These changes are most pronounced for patients over 40 years of age, and degenerative disc disease seems to account for much of this increase.