Neurosurgery
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Endoscopic evacuation of intraoperative hemorrhage is proving to be increasingly useful and effective. For general agreement that endoscopic evacuation has advantages over craniotomy, secure hemostatic procedures are crucial. ⋯ Even careful atraumatic evacuation of a hematoma can sometimes result in intraoperative hemorrhage. Repeated irrigation and point suctioning may be necessary to keep the operating field clear. A multifunctional suction cannula would be useful for maintaining irrigation and suction balance. Coagulation of a bleeding artery can be performed under clear visualization. A balanced irrigation-suction technique results in secure hemostasis.
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Historical Article
An eclectic review of the history of peripheral nerve surgery.
We take our present concepts of nerve repair for granted. In fact, the pioneers who established these principles traveled a road filled with erroneous dogma, bad advice, and misleading data. ⋯ In honor of Dr. David Kline's distinguished career, we will review 3 aspects of the history of peripheral nerve surgery: Can an injured nerve regain function? How do peripheral nerves regenerate? When should a neuroma in continuity be resected?
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Vascular endothelial growth factor (VEGF) enhances neurogenesis in ischemic brains. However, in most circumstances, endogenous VEGF expression is limited and insufficient to prevent brain damage. We transferred the VEGF gene into brain tissue with recombinant adeno-associated virus serotype 1 (rAAV1) vectors and determined the effect of VEGF expression on neurogenesis and recovery of neurological function after brain ischemia. ⋯ rAAV1-mediated expression of VEGF in the rat brain reduces the size of the infarcted lesion and promotes recovery of neurological function, likely by enhancing neurogenesis in the subventricular zone and promoting neural precursor migration to brain tissue around the core of the ischemic lesion.
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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.