Neurosurgery
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Biography Historical Article
Stereotactic navigation, Jean Talairach, and I.
This is not meant to be a comprehensive review of the work of Jean Talairach and his associates at the Centre Hospitalier Ste. Anne in Paris. Much more space than is available here would be required for that purpose. ⋯ Anne in 1937 at 28 years of age, has remained productive throughout his life and, even in his late eighties, continued to contribute to his field. His legacy is enormous. This work is simply meant to relate some of my personal anecdotes about Talairach and the people around him and to describe how the experience influenced my own career.
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The field of neurosurgery in the United States faces many challenges. Neurosurgical program directors in the United States represent a logical source for inquiries about manpower issues, the training process, and Residency Review Committee (RRC) oversight. ⋯ This survey suggests that a broader discussion of resident training issues would be valuable, perhaps using validated survey instruments.
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To describe the history of Robert Bentley Todd (1809-1860) and certain of his contributions to medicine, including his original and subsequent descriptions of "epileptic hemiplegia," which came to be called "Todd's paralysis." ⋯ Many neurologists and investigators followed Todd in acknowledging transient postictal paralysis as a distinct clinical entity. Yet whether the pathophysiology of "Todd's paralysis" is related to "neuronal exhaustion" or excessive inhibition is still controversial.
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A 6-year study was performed to determine the circumstances, causes, and outcomes of concussions in the National Football League. ⋯ The professional football players most vulnerable to concussions are quarterbacks, wide receivers, and defensive secondaries. Concussions involved 2.74 symptoms/injury, and players were generally removed from the game. More than one-half of the players returned to play within 1 day, and symptoms resolved in a short time in the vast majority of cases.
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Comparative Study
Age-dependent differences in short-term outcome after surgical or endovascular treatment of unruptured intracranial aneurysms in the United States, 1996-2000.
Unruptured intracranial aneurysm patients are frequently eligible for both open surgery ("clipping") and endovascular repair ("coiling"). We compared short-term end points (mortality, discharge disposition, complications, length of stay, and charges) for clipping and coiling in a nationally representative discharge database. ⋯ There was no significant difference in mortality rates or discharge to long-term facilities after clipping or coiling of unruptured aneurysms. When discharge to short-term rehabilitation was counted as an adverse event, coiled patients had significantly better outcomes than clipped patients at the time of hospital discharge, but most of the coiling advantage was concentrated in patients older than 65 years of age. Even in older patients, long-term end points-including long-term functional status in patients discharged to rehabilitation and efficacy in preventing hemorrhage-will be critical in determining the best treatment option for patients with unruptured aneurysms.