Neurosurgery
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Atlantoaxial rotatory fixation (AARF) remains a recondite entity loosely included under the panoply of cervical trauma. The difficulty in finding a precise definition and reliable diagnostic criteria for AARF has been chiefly because of a lack of normative biomechanical data for C1-C2 rotation. As Part 1 and foundation of a comprehensive undertaking to define the biomechanics, mechanism, diagnosis, classification, and management of AARF, the present study focuses on the dynamic behavior of C1 and C2 during normal voluntary head rotation in children. ⋯ C1 and C2 in children move in a predictable manner during axial head rotation, with a high degree of concordance among subjects and a relatively narrow variance from the mean. The composite motion curve can thus be used as a touchstone against which may be judged all manners of pathological interlock or "stickiness" between C1 and C2 in rotation that could be defined as AARF.
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Biography Historical Article
Surgery of involuntary movements, particularly stereotactic surgery: reminiscences.
WHEN WE STARTED using stereotactic surgery in 1953, the existing stereotactic instruments required general anesthesia for fixation of the head. We designed a stereotactic instrument with target screens that could be fixed to the patient's head under local anesthesia. ⋯ The active muscles were identified by electromyography and blocked with 1% lidocaine, resulting in marked but temporary improvement. It was decided to use selective peripheral denervation in these cases with very satisfactory results, and it became the only procedure we used for the relief of spasmodic torticollis.
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The purpose of this study is to clarify whether venous compression on the trigeminal nerve really causes trigeminal neuralgia or not, and to identify which veins are the offending veins. ⋯ Our surgical experiences showed that venous compression could cause trigeminal neuralgia by itself and that the transverse pontine vein should be carefully observed because it is most frequently the offending vein.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of endovascular and surface cooling during unruptured cerebral aneurysm repair.
To compare endovascular versus surface methods for the induction and reversal of hypothermia during neurosurgery in a multicenter, prospective, randomized study. ⋯ Endovascular cooling provided superior induction, maintenance, and reversal of hypothermia compared with the surface blanket, without an increase in complications. Endovascular cooling may have clinical benefit for patients undergoing cerebrovascular surgery, as well as patients with acute stroke, head injury, or acute myocardial infarction.
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Multicenter Study Comparative Study
Correlation between withdrawal symptoms and medication pump residual volume in patients with implantable SynchroMed pumps.
To investigate whether patients with implantable SynchroMed pumps (Medtronic, Inc., Minneapolis, MN) develop symptoms of drug withdrawal at residual medication volumes that exceed 2 ml (the alarm residual volume recommended by the manufacturer). ⋯ Some patients develop symptoms of drug withdrawal at residual volumes that exceed 2 ml. We could not identify factors that predict this occurrence. Withdrawal symptoms did not recur when the alarm volume was increased to 4 ml.