Neurosurgery
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Review Case Reports
Fatal subarachnoid hemorrhage, with brainstem and cerebellar infarction, caused by Aspergillus infection after cerebral aneurysm surgery: case report.
Intracranial aspergillosis has been reported to cause subarachnoid hemorrhage (SAH) attributable to ruptured mycotic aneurysms. We describe a case of Aspergillus arteritis that caused SAH without aneurysm formation, followed by successive brainstem and cerebellar infarction. ⋯ When a patient presents with SAH of unknown origin followed by cerebral infarction, Aspergillus arteritis should be included in the differential diagnosis. Earlier recognition of this fungal infection improves the prognosis.
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Review Case Reports
Ganglioglioma presenting as a meningioma: case report and review of the literature.
Gangliogliomas are intra-axial, avascular masses located predominantly in the temporal lobe. A ganglioglioma that mimics a meningioma in that it is extra-axial and has a significant extracranial vascular supply has not been reported previously. ⋯ This report confirms that gangliogliomas can present as extra-axial, vascular masses that are similar to meningiomas.
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Biography Historical Article
History of the Lahey Clinic department of neurosurgery.
THIS HISTORY OF one of the early departments of neurosurgery provides some perspective on the changing practice of this specialty during its formative years. Under the guidance of James L. Poppen and Gilbert Horrax, the Department of Neurosurgery at the Lahey Clinic assumed a prominent role in extending Harvey Cushing's methods, enlightened by Poppen's techniques, many of which were ahead of their time, and provided inspiration to the next generations of neurosurgeons. Although the pattern of neurosurgery has changed remarkably in the past 70 years, basic principles have remained much the same.
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To assess the efficacy and complication rates of magnetic resonance imaging-guided stereotactic limbic leukotomy for the treatment of intractable major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). ⋯ For this cohort of 21 patients with chronic severe MDD or OCD, who had experienced failure with an exhaustive array of previous treatments, limbic leukotomy was associated with substantial benefit for 36 to 50%. This rate is comparable to those of previous studies of limbic system surgery and indicates that limbic leukotomy is a feasible treatment option for severe, treatment-refractory MDD or OCD. Adverse consequences associated with the procedure included affective, cognitive, and visceromotor sequelae, which were generally transient.
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To determine the frequency and characteristics of microembolic signals (MES) in subarachnoid hemorrhage (SAH). ⋯ MES were common in SAH, occurring in 70% of cases of SAH and one-third of all vessels monitored. Although MES were more frequent among patients with clinical vasospasm, this difference did not reach statistical significance. We were unable to demonstrate a relationship between ultrasonographic vasospasm and MES, and the presence of a proximal secured or unsecured aneurysm did not alter the chance of detection of MES. Further studies are required to determine the origin and clinical relevance of MES in SAH.