Neurosurgery
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To document the value of bilateral anterior cingulotomy for patients with intractable chronic noncancer pain. ⋯ Bilateral anterior cingulotomy is safe for patients with refractory chronic pain. Seizures reported in this series were well controlled with medication. More than half of all respondents thought they had a positive outcome and that cingulotomy was beneficial to them. There were no deaths related to the procedure.
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Microneurosurgery is Professor Yaşargil's legacy. Its impact on patient outcomes, surgeons' abilities, the field of neurosurgery in particular, and the art of surgery in general is great, profound, and everlasting. Professor Yaşargil led a revolution that has transformed neurosurgery into the fine art we practice today. ⋯ It has been an honor, a great opportunity, and a phenomenal experience to spend the last 5 years with him at the University of Arkansas for Medical Sciences in Little Rock. There, he represents the very best in knowledge, expertise, dexterity, and, above all, devotion to advancing the field of neurosurgery. Most enjoyable have been his stimulating intellect and inspiring vision.
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Intracerebral microdialysis has been demonstrated to be a useful method for detection of brain ischemia in experimental models and in patients. We have applied new mobile microdialysate analysis equipment that allows a bedside comparison of changes in neurochemistry with the neurological status of the patient. Ten patients with severe aneurysmal subarachnoid hemorrhage (that is, with a high risk of vasospasm and a high risk of subsequent ischemic deficits) were selected. ⋯ Bedside intracerebral microdialysis monitoring of patients with subarachnoid hemorrhage and signs of delayed ischemia revealed dramatic changes in extracellular concentrations of glucose, lactate, and glycerol that could be directly correlated to the clinical status of the patients. These findings emphasize the potential of microdialysis in neurosurgical intensive care patients.
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The high cost of technology is considered to be the determining factor slowing the expansion of modern neurosurgery in many developing countries. The literature dedicated to this topic rarely proposes internal solutions whereby affected countries can overcome this economic impediment. Certain articles cite inevitable obstacles, and the neurosurgeons of these countries can become disheartened when these articles conclude with calls for foreign help as the only approach to the development of neurosurgery. ⋯ Neurosurgery in developing countries can be promoted if the first working neurosurgeons take up their responsibilities as pioneers. This role requires that they initiate the training of young neurosurgeons as soon as possible and that they find in the local conditions the necessary factors to promote neurosurgery and to integrate it into the health care development of their country.