Neurosurgery
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Elevated mean cerebral blood flow velocity (mCBFV) on transcranial Doppler predicts vasospasm of the large intracranial arteries after aneurysmal subarachnoid hemorrhage (aSAH). The pulsatility index (PI) is a measure of distal vascular resistance, which may be low when there is compensatory distal vasodilatation following hypoperfusion caused by large-vessel vasospasm. ⋯ Low PI on TCCD is an independent predictor of SLVVS after aSAH, whereas mCBFV is a better predictor of angiographic vasospasm.
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Synovial sarcoma (SS) is a malignant soft-tissue tumor that rarely involves brachial plexus. The authors report a case of brachial plexus SS and review the relevant literature. ⋯ Lack of any recurrence in this case 6 years after incomplete excision with no adjuvant therapy suggests slow clinical course in some of these sarcomas.
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Emissary veins connect the extracranial venous system with the intracranial venous sinuses. These include, but are not limited to, the posterior condyloid, mastoid, occipital, and parietal emissary veins. ⋯ Detailed descriptions of these venous structures are lacking in the literature, and, to the authors', knowledge, this is the first detailed review to discuss the anatomy, pathology, anomalies, and clinical effects of the cranial emissary veins. Our hope is that such data will be useful to the neurosurgeon during surgery in the vicinity of the emissary veins.
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The suppression of the growth hormone (GH) on an oral glucose tolerance test (OGTT) has been accepted as the most reliable parameter for determining remission of acromegaly. ⋯ Immediate postoperative GH level is a very good predictor of long-term outcome in acromegaly. One-week postoperative OGTT is also a good predictor with high specificity. These findings may provide critical information for the determination of adjuvant treatment after surgery.
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Mannitol has traditionally been the mainstay of medical therapy for intracranial hypertension in patients with head injury. We previously demonstrated that mannitol reduces brain volume in patients with cerebral edema, although whether this occurs because of a reduction in brain water, blood volume, or both remains poorly understood. ⋯ A single bolus of 1 g/kg of 20% mannitol does not acutely lower CBV. Another mechanism, such as a reduction in brain water, may better explain mannitol's ability to lower intracranial pressure and reduce mass effect.