Neurosurgery
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Biography Historical Article
A neuroforensic analysis of the wounds of President John F. Kennedy: Part 2--A study of the available evidence, eyewitness correlations, analysis, and conclusions.
A substantial body of literature exists surrounding the assassination and subsequent pathological examination of President John F. Kennedy. In the first part of this series, we provided a previously undocumented eyewitness account by a neurosurgeon of what transpired in Trauma Room 1 of Parkland Memorial Hospital on November 22, 1963. ⋯ The autopsy report, ballistics data, official reviews of the autopsy data, and Dr. Grossman's observations are correlated in an effort to provide a neuroforensic analysis of the nature of the wounds that President Kennedy sustained. The final article of the series will relate the wounds to the timing of the shots and the location of the President as his limousine traversed Dealey Plaza and will discuss the sites from which the bullets could have been fired.
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Atlantal lateral mass screws provide an alternative to C1/C2 transarticular screws and, in some cases, can obviate the need for extending a fusion to the occiput. For these reasons, C1 lateral mass screws are becoming increasingly popular. However, the critical local anatomy and unfamiliarity with this new technique can make C1 screw placement more challenging. ⋯ Significant variations in the morphology of C1 exist. However, the large size of the atlantal lateral mass makes screw placement forgiving. Preoperative computed tomographic scans and intraoperative fluoroscopy are useful in guiding proper screw placement. Close attention should be paid to preparation of the screw entry site.
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Case Reports
Extensive spinal cord infarction after posterior fossa surgery in the sitting position: case report.
Spinal cord injury is a rare complication of neurosurgery performed with the patient in the sitting position. Previous reports showed that the level of injury is usually located at or near the C5 segmental spinal level, and the term midcervical quadriplegia has been proposed. Extensive spinal cord and lower brainstem infarction also can occur after posterior fossa surgery performed with the patient in the sitting position. ⋯ We speculate that alteration of spinal cord blood flow by stretching of the cervical spinal cord and spinal epidural venous engorgement might have caused this devastating complication.
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Case Reports
Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils.
The long-term durability of the endovascular occlusion of cerebral aneurysms is one of the major factors limiting the more widespread use of this technique. Long-term occlusion of wide-necked aneurysms has improved with new assistive devices that seem to improve aneurysm occlusion while protecting the parent vessel. We report the use of a new intracranial stent--the Neuroform microstent--in the treatment of patients with wide-necked cerebral aneurysms. ⋯ Intracranial stenting may overcome important technical limitations in current endovascular therapy by improving the occlusion of wide-necked aneurysms while protecting the parent vessel.
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Serum brain natriuretic peptide (BNP) is elevated after subarachnoid hemorrhage (SAH), causes diuresis and natriuresis (cerebral salt wasting), and may exacerbate delayed ischemic neurological deficits. We examined the temporal relationship between serum BNP elevation, hyponatremia, and the onset of delayed ischemic neurological deficits and determined whether serum BNP levels correlated with the 2-week outcome after SAH. ⋯ Increasing serum BNP levels independently were associated with hyponatremia, significantly increased the first 24 hours after onset of delayed ischemic neurological deficits, and predicted the 2-week Glasgow Coma Scale score.