Neurosurgery
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Case Reports
C1-C2 pedicle screw fixation with rigid cantilever beam construct: case report and technical note.
Transarticular screw fixation of the C1-C2 complex provides immediate rigid fixation of the unstable spine. The technique is not feasible in a certain proportion of patients because of the position of the vertebral artery or the patient's body habitus. ⋯ This technique is technically more forgiving than posterior transarticular screw fixation and may be applied to a broader spectrum of patients.
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Meta Analysis Comparative Study
Timing of aneurysm surgery in subarachnoid hemorrhage: a systematic review of the literature.
Many practitioners favor early operation after aneurysmal rupture, but sound data supporting this practice are lacking. A systematic review was conducted to compare early aneurysm surgery (Days 0-3), intermediate surgery (Days 4-7), and late surgery (more than 7 d after subarachnoid hemorrhage). ⋯ This meta-analysis suggests that both early and intermediate surgical treatment improve outcome after aneurysmal subarachnoid hemorrhage--in particular for patients in good clinical condition at admission. However, this impression is derived only from an indirect comparison between different cohorts of patients. Sound evidence on the best timing of surgery is still lacking. Observational studies with better methods--and ideally a new randomized trial--are needed.
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We report two cases of massive intraventricular hemorrhage resulting from subarachnoid hemorrhage. Both patients had experienced a ruptured cerebral aneurysm and were initially moribund. The patients were treated with Guglielmi detachable coiling and then administration of intraventricular tissue plasminogen activator (tPA). Rapid clot resolution was demonstrated radiographically in both. Both patients survived and had a meaningful functional neurological recovery. These are the first reported cases of the acute use of intraventricular tPA after Guglielmi detachable coiling treatment for ruptured cerebral aneurysm. ⋯ This is a novel method to manage patients with high-grade aneurysms with massive intraventricular blood clots. The tPA reduced the mass effect of the blood clot, possibly helping to improve the neurological grade; in addition, the administration of tPA helped keep the external ventricular drains functional, enabling treatment of the acute hydrocephalus. The safety of administering tPA after endovascular thrombosis was demonstrated in these two patients. Further investigation is required to determine the applicability of this approach on a broader scale.
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This study was undertaken to assess the acute safety and feasibility of rapidly inducing, maintaining, then reversing hypothermia using a novel heat transfer catheter and a closed-loop automatic feedback temperature control system to overcome limitations imposed by current clinical practices used for perioperative cooling and warming. ⋯ The data presented here suggest that rapid induction and reversal of hypothermia are technically possible using a core intravenous cooling catheter; this method would provide a safe, rapid, and exquisitely reproducible way to induce hypothermia with subsequent restoration of normothermia.
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Biography Historical Article
A flask full of jelly: the first in vitro model of concussive head injury--1830.
IN 1830, THE French Military Surgeon Jean-Pierre Gama reported an experiment planned to unravel the mechanical events caused by head injury. His model was a round glass flask with a long neck filled with a gelatinous substance that resembled the consistency of the brain. ⋯ Although it was crudely constructed, entirely subjective as to evaluation of results, and lacking the essential instrumentation that only modern technology can provide, this hypothesis-driven pioneer experiment should be regarded as the first to use the novel approach of physical modeling of the brain. Even today, this approach has not been fully exploited.