Neurosurgery
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The structural complexity of terminal myelocystocele (TMC) precludes a recognizable link to spinal cord development and therefore a plausible embryogenetic theory. ⋯ Besides tethering, the myelocystocele may show early rapid expansion causing precipitous deterioration. We recommend early repair with resection of the nonfunctional caudal cyst wall, reconstruction of the proximal neural placode, and duraplasty.
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Radiosurgery is widely used to treat deep eloquent arteriovenous malformations (AVMs). ⋯ Deep eloquent AVMs <4 cm can be treated safely and effectively with radiosurgery. Obliteration of peritectal AVMs is significantly lower after a single treatment. However, morbidity is low, and repeat treatment leads to good obliteration. Radiosurgical treatment >4 cm in the brainstem is not recommended. Supratentorial deep AVMs >8 cm can be treated with radiosurgery with higher risk and lower obliteration rate. However, these lesions are difficult to treat with other treatment modalities, and a 50% success rate makes radiosurgery a good alternative even in this challenging group.
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Radiofrequency thermorhizotomy of the trigeminal nerve is a known treatment of trigeminal neuralgia. Analysis of verbal responses to electric stimulation of the trigeminal rootlets has been the only method available to localize the affected branch, but patient discomfort may lead to unreliable verbal responses, resulting in increased morbidity or even therapeutic failure. Orthodromically elicited evoked potentials of the trigeminal nerve have also been used, but their application is tedious and results may vary. ⋯ This method proved to be useful to determine the exact localization of individual subdivisions of the trigeminal nerve in anesthetized patients, making this procedure safer and more comfortable for them.
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Fusiform intracranial aneurysms (FIAs) are challenging to treat by surgical and endovascular means because of their complex morphology and configurations. Various surgical techniques, including clip reconstruction, wrapping with or without clip enforcement, and trapping with or without bypass, have been described extensively. The objective of this study is to describe the application of a new fenestrated clip (Yaşargil T-bar clip) for the treatment of FIAs. ⋯ Clip reconstruction of an FIA with a fenestrated Yaşargil T-bar clip is a new application option that effectively reconstructs the parent artery. Application of this type of a clip might be advantageous over conventional fenestrated or nonfenestrated clip applications, especially in tight surgical fields, because a single clip might be sufficient to reconstruct the long segment of the artery.
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The Accreditation Council for Graduate Medical Education resident duty-hour restrictions were implemented in July 2003 based on the supposition that resident fatigue contributes to medical errors. ⋯ The implementation of the Accreditation Council for Graduate Medical Education resident duty-hour restrictions was associated with increased complications and no change in mortality for neurotrauma patients in teaching hospitals. In nonteaching hospitals, there was no change in complications and mortality. The occurrence of a complication was associated with longer length of stay and higher hospital charges in both time periods in both teaching and nonteaching hospitals.