Neurosurgery
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To analyze treatment procedures and treatment outcomes of painful missile-caused nerve injuries and factors influencing the outcome. ⋯ The treatment outcome of painful nerve injury depends on several factors, including the type of pain syndrome, severance of nerve injury, and absence of pain paroxysms. Drug therapy (carbamazepine, amitriptyline, or gabapentin) should be recommended, at least as a part of treatment, for patients with reinnervation pain, deafferentation pain, and complex regional pain syndrome Type II. Nerve surgery should be recommended for patients with posttraumatic neuralgia, either as the first treatment choice (acute nerve compression or intraneural foreign particles) or after unsuccessful pharmacological treatment (other causes of neuralgic pain).
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Review Meta Analysis
Treatment of ruptured intracranial aneurysms: looking to the past to register the future.
The outcomes reported in the International Subarachnoid Aneurysm Trial (ISAT), a multicenter, prospective, randomized trial to directly compare surgical clipping with endovascular coiling as treatments for ruptured intracranial aneurysms, have been misinterpreted by many to indicate the superiority of coiling to surgical clipping in all instances. To better understand the results of ISAT and their implications for practice patterns, we compared the ISAT results with the results of other published studies regarding the treatment of ruptured intracranial aneurysms. ⋯ Discrepancies with the results of other published studies, procedural limitations in study design, and lack of some data endpoints and subgroup analysis raise concerns regarding extracting generalizations from the conclusions of ISAT. We think that the creation of a national registry would further the study of treatment of ruptured intracranial aneurysms.
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Clinical Trial
Long-term results of microsurgical treatment of lumbar spinal stenosis by unilateral laminotomy for bilateral decompression.
Laminectomy and bilateral laminotomy are the standard procedures for decompression of lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability, the technique of unilateral laminotomy for bilateral decompression (ULBD) was developed. However, limited follow-up data exist to determine the efficiency and outcome of ULBD. Therefore, the authors present their 10-year experience with ULBD and postoperative long-term results. ⋯ ULBD allows achievement of good and long-lasting operative results in patients with LSS. Postoperative deterioration, recurrences, and spinal instability are infrequent. For the authors, ULBD is the preferred technique to treat symptomatic LSS.
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Biography Historical Article
Clarence Sumner Greene, Sr.: the first African-American neurosurgeon.
Largely because of the advances of the Civil Rights movement in the mid-20th century, an increasing number of African-Americans have had the opportunity to become physicians and enter the distinguished field of neurosurgery. Many have made the most of this opportunity, becoming prominent in both academics and private practice. Unfortunately, the details regarding the first African-American neurosurgeon, Clarence Sumner Greene, Sr., have remained in relative obscurity. ⋯ S. enabled him to overcome incredible odds to become the first African-American neurosurgeon, trained by Dr. Penfield at the Montreal Neurological Institute. A true pioneer, his achievements have opened the door for subsequent African-Americans to enhance the field of neurosurgery.
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Controlled Clinical Trial
A population-based study of neurosurgical and endovascular treatment of ruptured, intracranial aneurysms in a small neurosurgical unit.
Since the introduction of endovascular embolization, the optimal treatment of ruptured aneurysms has been debated. Much of this debate has been based on results from large neurovascular centers and may not be applicable to small neurosurgical centers with low annual aneurysm loads. We think that the results of small centers, such as ours, may also be of some interest. ⋯ At present in our hospital, the endovascular modality seems to yield a better clinical outcome than surgery and has become our treatment of choice. With increasing use and further refinement of the endovascular techniques, the difference in outcomes between the treatment modalities will probably change even further in favor of the endovascular technique.