Neurosurgery
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Long spinal constructs that extend to the sacrum place added stress on sacral screws. To prevent premature loosening of sacral fixation in these cases, the addition of pelvic screw (iliac screw) fixation has gained in popularity. Pelvic screw fixation has also been used in cases where sacral screw fixation is not possible (e.g., in sacral tumors). Pelvic screw fixation is more straightforward than prior pelvic rod fixation techniques (e.g., the Galveston technique). We describe our technique for pelvic screw fixation and review our experience with this technique. ⋯ Pelvic screw fixation is a safe and effective technique that provides added structural support to S1 screws in long-segment spinal fusions. Furthermore, pelvic screw fixation provides a distal point of fixation in cases where sacral screw fixation is not possible. The use of polyaxial screws and connectors makes this technique easier than Galveston rod fixation of the pelvis.
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Spinal deformity is the oldest disease known to humankind. The first record of correction of spinal deformity was documented in an Indian religious mythological book written between 3500 BC and 1800 BC. Initially, all spinal deformities were treated with the use of braces, traction, or casts. ⋯ This concept allowed surgeons to begin to achieve three-dimensional corrections by respecting both the sagittal and coronal curves simultaneously. The introduction of pedicle screws, throughout the thoracolumbar spine, has increased the ability of surgeons to achieve greater degrees of curve correction than had previously been possible. The history of spinal deformity is still maturing as newer procedures continue to be performed on a daily basis.
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Historical Article
The Harvard Neurosurgical Service at the Children's Hospital Boston and Brigham & Women's Hospital, 1912-2007.
The Harvard Neurosurgical Service at Brigham and Women's Hospital and Children's Hospital Boston has a distinguished history, beginning in 1912 when Dr. Harvey Cushing became surgeon-in-chief at the Peter Bent Brigham Hospital. After Cushing left in 1932, the Children's Hospital had a dominant role, with the creation and development of pediatric neurosurgery under Franc D. ⋯ Despite reporting on more than 2500 cases a year, the combined service continued to have a strong academic program. This was helped by a residency with two required research years, an academic day each week, faculty committed to research, strong scientific collaborations, and contributions from many visiting neurosurgeons and research fellows. In its first 94 years, the service has been a strong force in clinical, educational, political, and research efforts in neurosurgery.
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Multicenter Study Comparative Study
Validation of an aneurysmal subarachnoid hemorrhage grading scale in 1532 consecutive patients.
The two most commonly used aneurysmal subarachnoid hemorrhage grading scales are the Hunt and Hess and World Federation of Neurological Societies scales. Neither has achieved universal acceptance, however, owing to concerns regarding either subjectivity or lack of correlation with outcomes, respectively. A grading scale based entirely on the Glasgow Coma Scale (GCS) was recently proposed. We have prospectively evaluated the GCS grading system and compared it with the Hunt and Hess and World Federation of Neurological Societies scales for predictive accuracy. ⋯ The GCS grading system is more strongly associated with outcomes than either the Hunt and Hess or World Federation of Neurological Societies scales, and it is an equivalent to a slightly better predictor of Glasgow Outcome Scale outcomes. Its simplicity, proven inter-rater reliability, and wide level of familiarity among health care personnel render the GCS grading system a superior grading scale for aneurysmal subarachnoid hemorrhage severity, warranting its consideration for universal use.
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Comparative Study
Fever burden and functional recovery after subarachnoid hemorrhage.
Fever is associated with worse outcome after subarachnoid hemorrhage, but there are few prospective data to quantify this relationship. ⋯ Cumulative fever burden was associated with worse outcomes in good-grade patients and potential late recovery in poor-grade patients. Effective fever control in febrile subarachnoid hemorrhage patients may improve functional outcomes and hasten recovery.