Neurosurgery
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Clinical Trial
Hypertonic saline and its effect on intracranial pressure, cerebral perfusion pressure, and brain tissue oxygen.
Hypertonic saline is emerging as a potentially effective single osmotic agent for control of acute elevations in intracranial pressure (ICP) caused by severe traumatic brain injury. This study examines its effect on ICP, cerebral perfusion pressure (CPP), and brain tissue oxygen tension (PbtO2). ⋯ Hypertonic saline as a single osmotic agent decreased ICP while improving CPP and PbtO2 in patients with severe traumatic brain injury. Patients with higher baseline ICP and lower CPP levels responded to hypertonic saline more significantly.
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Review Case Reports
Surgical management of spinal catheter granulomas: operative nuances and review of the surgical literature.
Spinal catheter granulomas are a rare and, most likely, underreported complication of intrathecal opioid therapy. Such granulomas can be associated with devastating neurological sequelae if not treated in a timely fashion. Most neurosurgeons, however, are unlikely to have had experience in the surgical management of this condition. ⋯ The operative management of spinal intrathecal granulomas associated with opioid infusion pumps can be challenging and depends on a high degree of clinical suspicion, imaging results, and operative findings.
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Multicenter Study
Five-aminolevulinic acid for fluorescence-guided resection of recurrent malignant gliomas: a phase ii study.
To assess the feasibility of 5-aminolevulinic acid (5-ALA) fluorescence guidance for resection of recurrent malignant brain tumors. ⋯ 5-ALA fluorescence has a high predictive value for the detection of tumor in recurrent gliomas. Prior treatment modalities, such as radiation or chemotherapy, do not invalidate the fluorescence guidance with 5-ALA. 5-ALA fluorescence guidance is an effective surgical adjunct in the surgery of recurrent malignant gliomas.
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We present observations of the anatomy of the sylvian fissure region and their clinical application in neuroimaging, microsurgery for middle cerebral artery aneurysms and insular lesions, frontobasal resections, and epilepsy surgery. ⋯ The anatomic relationships of the sylvian fissure region can be helpful in preoperative planning and can serve as reliable intraoperative navigation landmarks in microsurgery involving that region.
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Comparative Study
Radiographic and anatomic basis of endoscopic anterior craniocervical decompression: a comparison of endonasal, transoral, and transcervical approaches.
To evaluate surgical access to the craniocervical junction using 3 endoscopic approaches: endonasal, transoral, and transcervical. ⋯ The endonasal and transoral approaches allow wide exposure with large working angles to the craniocervical junction. The transcervical approach accesses the odontoid for resection from the body of C2 to the lip of the basion. The angles of attack in the transcervical approach when centered on the surgical target are limited, but this approach offers a clean, sterile operative field. Clinical investigation will be required to determine the optimal indications for each approach.