Neurosurgery
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Multicenter Study Clinical Trial
Preliminary clinical experience with the Bryan Cervical Disc Prosthesis.
The concept of accelerated degeneration of adjacent disc levels as a consequence of increased stress caused by interbody fusion of the cervical spine has been widely postulated. Therefore, reconstruction of a failed intervertebral disc with a functional disc prosthesis should offer the same benefits as fusion while simultaneously providing motion and thereby protecting the adjacent level discs from the abnormal stresses associated with fusion. This study was designed to determine whether a new, functional intervertebral cervical disc prosthesis can provide relief from objective neurological symptoms and signs, improve the patient's ability to perform activities of daily living, decrease pain, and provide stability and normal range of motion. ⋯ Discectomy and implantation of the device alleviates neurological symptoms and signs similar to anterior cervical discectomy and fusion. Radiographic evidence supports normal range of motion. The procedure is safe and the patients recover quickly. Restrictive postoperative management is not necessary. However, only after long-term follow-up of at least 5 years will it become clear whether the device remains functional, thus confirming these early favorable results. In addition, the influence on adjacent motion segments can be assessed after at least 5 years of follow-up.
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Spontaneous intracranial hypotension is an increasingly recognized cause of postural headache. However, appropriate management of obtundation caused by intracranial hypotension is not well defined. ⋯ Spontaneous intracranial hypotension may cause a decline of mental status and require lumbar intrathecal saline infusion to arrest or reverse impending central (transtentorial) herniation. This case demonstrates the use of simultaneous monitoring of lumbar and intracranial pressures to appropriately titrate the infusion and document resolution of intracranial hypotension. Maneuvers aimed at sealing the cerebrospinal fluid fistula then can be performed in a less emergent fashion after the patient's mental status has stabilized.
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Specific guidelines for documenting the complete loss of brain function, for the declaration of brain death, have been established for 3 decades. This study assessed the quality and completeness of brain death notes and the effects of delays between notes on organ procurement. ⋯ To meet the needs of organ recipients and donor families and to comply with hospital, legal, and legislative mandates, hospitals may need to increase quality assurance activities with respect to declarations of brain death. Increased physician education should improve awareness of uniform brain death declaration guidelines.
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Our aim was to evaluate the efficacy of stereotactic radiosurgery (SRS) for the treatment of patients with brain metastases that have been determined to be "radioresistant" on the basis of histological examination. ⋯ Well-selected patients with brain metastases from radioresistant primary tumors who undergo SRS survive longer than historical controls. RPA Class I status and primary renal cell carcinoma predict longer survival. Adjuvant WBRT improves local control and decreases DBF but does not affect overall survival. Further studies are needed to determine which patients should receive WBRT.
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Case Reports
Unusual migration of the distal catheter of a ventriculoperitoneal shunt into the heart: case report.
Placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus. Thoracic complications with VP shunts are rare, but we present the second documented case of the distal migration of the distal catheter of a VP shunt into the heart. ⋯ The migration of the distal catheter probably occurred during the initial VP shunt placement. The internal jugular vein probably was perforated by the tunneler during the creation of the distal catheter tract. Slow venous flow and negative inspiratory pressure may have gradually pulled the catheter up into the right atria and ventricle. As demonstrated by our case report, the catheter can be extracted safely in a joint procedure with cardiac surgeons, and a thoracotomy is not always necessary. The patient did not experience postoperative complications, and his hypertension was alleviated.