Neurosurgery
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Subdural rhabdomyosarcoma is very rare, and even more unusual is the association between these sarcomas and chronic subdural hematoma. In this report, we present a case of subdural rhabdomyosarcoma that developed in a chronic refractory subdural hematoma. ⋯ Whether the subdural hematoma or the tumor was the initial pathology is debatable. We think the sarcoma probably developed gradually because of chronic inflammation and proliferation in the subdural collection.
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Randomized Controlled Trial Multicenter Study
Predictors of cerebral infarction in patients with aneurysmal subarachnoid hemorrhage.
Cerebral infarction would be expected to be associated with poor outcome after aneurysmal subarachnoid hemorrhage (SAH), although there are few data on which to base this assumption. The goals of this study were to determine the impact of cerebral infarction on outcome and to examine predictors of infarction in these patients. ⋯ Cerebral infarction was strongly associated with poor outcome after aneurysmal SAH. The most important potentially treatable factor associated with infarction was symptomatic vasospasm.
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Clinical Trial
Neuronavigation without rigid pin fixation of the head in left frontotemporal tumor surgery with intraoperative speech mapping.
Intraoperative speech mapping has evolved into the "gold standard" for neurosurgical removal of lesions near the language cortex. The integration of neuronavigation into a multimodal protocol can improve the reliability of this type of operation, but most systems require rigid fixation of the patient's head throughout the operation. This article describes and evaluates a new noninvasively attached sensor-based reference tool, which can replace rigid pin fixation of the patient's head during awake craniotomies. ⋯ The use of a reference sensor can replace uncomfortable pin fixation of the patient's head during navigation-supported awake craniotomies. Application accuracy is not affected by repositioning of the patient or by unavoidable head movements. Thus, this technique enables full exploitation of the benefits of navigation in a multimodal operative protocol without the need to rigidly fix the patient's head.
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Surgical correction of thoracic kyphotic deformity is often associated with significant surgical and neurological morbidity and unsatisfactory reduction of kyphosis, especially in patients who cannot tolerate anterior thoracic procedures because of associated comorbidity. We describe a technique in which kyphotic deformity of the thoracic and thoracolumbar spine is corrected, decompressed, and stabilized with a circumferential fixation construct from a lone posterior approach. ⋯ This technique allows for circumferential decompression of the spinal cord via a posterior approach in patients with thoracic kyphotic deformities who cannot tolerate anterior thoracic approaches. In addition, in situ distraction of the expandable cage allows correction of sagittal imbalance and restores height without the potential loss of spinal height associated with osteotomies.
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Case Reports
Intraoperative application of thermography in extracranial-intracranial bypass surgery.
The extracranial-intracranial bypass may have the potential to improve hemodynamic cerebral ischemia caused by occlusive diseases of the main cerebral arteries. Intraoperative confirmation of effective distribution of blood flow via the donor arteries to the involved region will assure a successful bypass surgery. ⋯ Thermography is useful not only to demonstrate the distribution of blood flow through the extracranial-intracranial bypass but also to quantitatively evaluate the rCBF changes in the operative field.