Neurosurgery
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Multicenter Study
Gamma knife radiosurgery for cerebellopontine angle meningiomas: a multicenter study.
Resection of cerebellopontine angle (CPA) meningiomas may result in significant neurological morbidity. Radiosurgery offers a minimally invasive alternative to surgery. ⋯ GKRS is an effective therapy for CPA meningiomas. Depending on the patient and tumor characteristics, radiosurgery can be an adjuvant treatment to initial surgical resection or a standalone procedure that obviates the need for resection in most patients.
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The treatment of C8T1 avulsion is challenging for neurosurgeons. Various methods for the restoration of finger flexion are used. However, most of these methods have different disadvantages and cannot restore the full active range of motion of the fingers. ⋯ The pronator teres can be transferred to the anterior interosseous nerve directly at the elbow level. This operation was performed successfully in 1 patient, who exhibited finger flexion recovery.
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Traumatic brain injury is the leading cause of death and disability in the world for adolescents according to the World Health Organization. Sports-related concussion is a small but perhaps one of the most preventable causes of that morbidity. Legislation to protect student athletes is one of the ways in which we can advocate for safety in sports. ⋯ This history is viewed from the point of view of one of the participants in the efforts to pass laws in all 50 states. The key provisions of the Zackery Lystedt Law include (1) education for parents, athletes, and coaches; (2) immediate removal from play during a game or practice, after a suspected concussion with no return to play until (3); (3) written clearance by a concussion expert for return to play; and (4) uniformity of rules for all schools who use public land. Last, the nature of this legislative process, which included attorneys, legislators, and physicians, demonstrated that effective collaboration of local, state, and national leaders can address a critical public health challenge such as concussion affecting student athletes.
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At least 300 000 sports-related concussions occur in the United States annually. With millions of American athletes, the long-term effects of repeated concussion or mild traumatic brain injury are an important topic. Unfortunately, there is a lack of strong data on the causality or prevalence of long-term effects among athletes. ⋯ Concern exists that athletes subject to repeated concussive and even subconcussive blows may be at risk of CTE, but no definitive data exist due to the difficulty in diagnosis. Animal models suggest that mild traumatic brain injuries lead to primarily a metabolic derangement with increased excitotoxic neurotransmitter release, extracellular potassium, and intracellular calcium. Further understanding of the underlying pathophysiology may eventually lead to better therapeutic and diagnostic options for the treating clinician.
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Comparative Study
Comparison of long-term outcomes associated with endovascular treatment vs surgical treatment among Medicare beneficiaries with unruptured intracranial aneurysms.
Long-term outcomes associated with endovascular and surgical treatments for unruptured intracranial aneurysms are not well studied to date. ⋯ In elderly patients with unruptured intracranial aneurysms, endovascular treatment was associated with lower rates of acute adverse events and long-term all-cause mortality and new intracranial hemorrhages.