Neurosurgery
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Intracerebral hemorrhage (ICH) has a high mortality rate and leaves most survivors disabled. The dismal outcome is mostly due to the mass effect of hematoma plus edema. Major clinical trials show no benefit from surgical or medical treatment. Decompressive craniectomy has, however, proven beneficial for large ischemic brain infarction with massive swelling. We hypothesized that craniectomy can improve ICH outcome as well. ⋯ Decompressive craniectomy performed up to 24 hours improved outcome after experimental ICH, with earlier intervention of greater benefit.
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Herein, we provide an unbiased review of piriformis syndrome (PS), a highly controversial syndrome for which no consensus exists regarding diagnostic criteria or pathophysiology. ⋯ PS remains a controversial diagnosis for sciatic pain. The debate regarding the clinical significance of PS remains active. Nonetheless, there may be a subset of patients in whom the piriformis muscle is a source of pain. The syndrome should be considered in the differential diagnosis of patients with unilateral lower extremity pain.
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The surgical treatment of cubital tunnel syndrome by various techniques is often met with disappointing results. An optimal treatment is not agreed upon. The authors propose a collection of techniques which they believe optimizes outcome and minimizes iatrogenic injuries. ⋯ The authors present a means of treating cubital tunnel syndrome. Failure of in situ cubital tunnel release, as with failure of any ulnar procedure, can be attributed to intraoperative ulnar nerve injury, injury to the medial antebrachial cutaneous nerve, inadequate longitudinal exploration and release, scar formation with recurrent compression and/or traction, and the possibility that decompression could lead to iatrogenic symptomatic nerve subluxation. The authors discuss the rationale for a minimalist open surgical approach for the treatment of cubital tunnel syndrome, and each of these concerns is addressed.
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With improvements in endovascular techniques, fewer aneurysms are treated by surgical clipping, and those aneurysms targeted for open surgery are often complex and difficult to treat. We devised a hollow, 3-dimensional (3D) model of individual cerebral aneurysms for preoperative simulation and surgical training. The methods and initial experience with this model system are presented. ⋯ Using the hollow 3D models to simulate clipping preoperatively, we could treat the aneurysms confidently during live surgery. These models allow easy and concrete recognition of the 3D configuration of aneurysms and parent vessels.
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Intraventricular hemorrhage (IVH) is a serious complication of intracerebral hemorrhage (ICH). We hypothesized that antiplatelet medication use and platelet activity would be associated with more IVH. ⋯ Reduced platelet activity was related to more IVH as a complication of ICH. The relationship of platelet activity to IVH deserves further study.