Neurosurgery
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This presentation is designed to share with fellow neurosurgeons a topic, namely the oath of Hippocrates, that has been a subject of fascination to physicians, scholars, historians, and even the public for the past 2500 years. Its moral and ethical message has exhibited remarkable resiliency through the ages, in varied cultures. Although its language may appear odd, its precepts are as valid today as they were in Hippocrates' time. ⋯ The longevity of the oath, however, is clearly attributable to its intrinsic merit, its high moral reverent tone, and a literary eloquence that placed Hippocrates among the best writers of antiquity. Despite the fame of its author, the oath has experienced a life of its own, from relative obscurity during the Dark Ages to reverential study since the Renaissance. Five aspects are considered in this discussion, i.e., 1) oaths in antiquity; 2) a biographical sketch of Hippocrates; 3) the chain of transmission from antiquity to modern times; 4) comments on other oaths, prayers, codes, and credos; and 5) an analysis and some personal views of the oath.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prophylactic hyperdynamic postoperative fluid therapy after aneurysmal subarachnoid hemorrhage: a clinical, prospective, randomized, controlled study.
To investigate the role of prophylactic hyperdynamic postoperative fluid therapy in preventing delayed ischemic neurological deficits attributable to cerebral vasospasm. ⋯ Neither early nor late outcome measures revealed any significant differences between the two subarachnoid hemorrhage treatment models.
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The goal of this report is to illustrate the use of radial artery grafts as bypass conduits in the management of complex intracranial aneurysms and to describe a new "pressure distension technique" to eliminate postoperative vasospasm, which was a common problem early in our experience. ⋯ Revascularization techniques are occasionally necessary for the surgical treatment of complicated intracranial aneurysms. The merits of the use of the radial artery as a bypass conduit are discussed. Radial artery grafts should be considered as alternatives to saphenous vein and superficial temporal artery grafts. The problem of vasospasm of the artery has been solved with the pressure distention technique.
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Hemorrhage associated with central neurocytoma has been described previously, but never in association with an aneurysm originating from a feeding artery. We present the first reported case of a central neurocytoma in a patient with intraventricular hemorrhage caused by rupture of an aneurysm on a lenticulostriate artery that supplied the tumor. ⋯ Previous reports have demonstrated that intraventricular neurocytoma may present with tumor hemorrhage. In this case, an aneurysm separate and distinct from the tumor was the bleeding culprit, and the aneurysm was on an artery that fed into the tumor. Any such aneurysm must be identified and treated appropriately for therapy to be complete.
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Indwelling intrathecal drug delivery systems are becoming increasingly important as a method of neuromodulation within the nervous system. In particular, intrathecal baclofen therapy has shown efficacy and safety in the management of spasticity and dystonia in children. The most common complications leading to explantation of the pumps are skin breakdown and infection at the pump implantation site. The pediatric population poses particular challenges with regard to these complications because appropriate candidates for intrathecal baclofen therapy are often undernourished and thus have a dearth of soft tissue mass to cover a subcutaneously implanted baclofen pump. We report a technique of subfascial implantation that provides greater soft tissue coverage of the pump, thereby reducing the potential for skin breakdown and improving the cosmetic appearance of the implantation site. ⋯ At this early follow-up, the subfascial implantation technique was associated with a reduced rate of local wound and pump infections and provided optimal cosmetic results as compared with that observed in retrospective cases.