Neurosurgery
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The sequelae of aneurysmal subarachnoid hemorrhage (SAH) include vasospasm and hydrocephalus. ⋯ Intraventricular tPA is a safe and effective treatment for reducing both angioplasty and shunting rates in patients with SAH H&H Grades 3 to 5. A randomized trial is indicated.
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Recurrent laryngeal nerve palsy (RLNP) occurs as a complication during anterior cervical spine surgery. In 2005 the authors demonstrated the high incidence of asymptomatic RLNP in a right-sided approach. ⋯ The left-sided approach in anterior cervical spine surgery reduces the incidence of postoperative and permanent RLNP significantly. Endotracheal cuff pressure reduction used additionally decreases the rate of RLNP even more. These results indicate that anterior cervical spine surgery should be performed with a left-sided approach and, if possible, with an additional reduction of the endotracheal cuff pressure while the retractors are inserted.
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Heat transfer from bipolar tips to adjacent tissue presents a risk of thermal injury during spine surgery. ⋯ Bipolar forceps that incorporate heat pipe technology limited thermal spread and reduced the extent of unintended injury to the spinal cord and collateral vessels.
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Case Reports
N-Butyl-2-cyanoacrylate use in intraoperative ruptured aneurysms as a salvage rescue: case report.
The use of N-butyl-2-cyanoacrylate (n-BCA) acrylic glue as a salvage rescue in procedural ruptured aneurysm should be part of the neurointerventionalist's armamentarium. ⋯ These 2 cases demonstrate a feasible technique for the salvage of iatrogenic aneurysm perforation during coil embolization, which, to our knowledge, has not been previously reported.
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Biography Historical Article
Salomón Hakim and the discovery of normal-pressure hydrocephalus.
Normal-pressure hydrocephalus (NPH) is a chronic neurological disorder characterized by enlarged ventricles and a triad of clinical symptoms affecting gait, cognition, and urinary continence. Salomón Hakim first identified the syndrome in 1957 at the Hospital San Juan de Dios in Bogotá, Colombia. Even after decades of international focus and thousands of publications on his disorder, Hakim's story remains largely untold. ⋯ As we learn more about NPH, the fascinating story of Professor Hakim, the father of NPH, is of both historical relevance and current interest.