Neurosurgery
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Biography Historical Article
Maister Peter Lowe and his 16th century contributions to cranial surgery.
Before the advent of neurosurgery as a discipline, various historic surgeons performed procedures on the skull and brain. One early pioneer of surgery, Peter Lowe (c. 1550-1612), not only wrote of methods of cranial surgery in his Chirurgerie, which was the first comprehensive text of surgery written in English, but also founded what would become the Royal Faculty of Physicians and Surgeons. ⋯ This 16th century Scottish surgeon trained in Paris, where he was influenced by Ambroise Paré and wrote about the "Spanish sickness." In his surgical text, Lowe wrote about his methods of multiple neurosurgical procedures. The present study discusses the life of Maister Peter Lowe and reviews his contributions to what became the art of neurosurgery.
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Comparative Study Clinical Trial
Comparative evaluation of percutaneous retrogasserian glycerol rhizolysis and radiofrequency thermocoagulation techniques in the management of trigeminal neuralgia.
Among the percutaneous procedures for the treatment of trigeminal neuralgia, percutaneous anhydrous glycerol rhizolysis (PRGR) and radiofrequency (RF) ablation of trigeminal neuralgia have stood the test of time. ⋯ Both PRGR and RF techniques can achieve acceptable pain relief with minimal side effects.
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The presence of osmotic gradients in the development of cerebral edema and the effectiveness of osmotherapy are well recognized. A modification of ventriculostomy catheters described in this article provides a method of osmotherapy that is not currently available. The reductive ventricular osmotherapy (RVOT) catheter removes free water from ventricular cerebrospinal fluid (CSF) by incorporating hollow fibers that remove water vapor, thereby providing osmotherapy without increasing osmotic load. ⋯ RVOT can increase CSF osmolarity in vivo after experimental traumatic brain injury (TBI). In anticipated clinical use, only a slight increase in CSF osmolarity may be required to reduce cerebral edema.
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Randomized Controlled Trial Comparative Study
A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy.
Controversy exists as to the best posterior operative procedure to treat multilevel compressive cervical spondylotic myelopathy. ⋯ In many respects, ECL compares favorably to CLF. Although the patient numbers were small, there were significant improvements in pain measures in the ECL group while still maintaining range of motion. Restoration of spinal canal area was superior in the CLF group.
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Multicenter Study Clinical Trial
Microdiscectomy improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc.
Emotional distress and depression are common psychological disturbances associated with low-back and leg pain. The effects of lumbar discectomy on pain, disability, and physical quality of life are well described. The effects of discectomy on emotional distress and mental well-being are less well understood. ⋯ The majority of patients somatized or depressed preoperatively returned to good mental well-being postoperatively. Improvement in pain and overall mental well-being was seen immediately after discectomy. Improvement in somatic anxiety and depression occurred months later. Microdiscectomy significantly improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc.