Neurosurgery
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To study the distribution of intracranial arachnoid cysts in a large and nonbiased patient population. ⋯ Arachnoid cysts have a strong predilection for the middle cranial fossa that may be explained by a meningeal maldevelopment theory: the arachnoid coverings of the temporal and frontal lobes fail to merge when the sylvian fissure is formed in early fetal life, thereby creating a noncommunicating fluid compartment entirely surrounded by arachnoid membranes. Why males develop more middle fossa cysts on the left side remains a mystery.
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To assess the potential for long-term serviceable hearing preservation in intracanalicular acoustic tumor patients who underwent stereotactic radiosurgery. ⋯ Gamma knife radiosurgery (using conformal dose planning, small-beam geometry, and < or = 14 Gy to the margin) prevents tumor growth and achieves excellent hearing preservation rates.
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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.
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Few recommendations have been outlined in the neurosurgical literature regarding when it is safe to initiate postoperative or posthemorrhage anticoagulation (AC), or for what duration it is safe to discontinue AC therapy in patients with clear indications for AC therapy. Our objective was to formulate guidelines for managing AC in neurosurgical patients, based on patients' needs for AC and the risk of complications. ⋯ Adequate preoperative correction of coagulation abnormalities and strict regulation of coagulation to avoid supratherapeutic AC is essential. Reintroduction of AC after an intracranial hemorrhage treated without surgery, or after a neurosurgical procedure, particularly an intracranial procedure, can be guided by determining whether the patient is at high, moderate, or low risk for thromboembolic complications. On the basis of experimental studies, the patient's thromboembolic risk, and the experience of other surgeons, we propose therapeutic options for use of AC in neurosurgical patients undergoing intracranial procedures.
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Historically, neurosurgery has improved the environment of the nervous system to promote maximal spontaneous recovery of function. The population of patients whom we treat at present is a small portion of those who suffer from disabling neurological illnesses. ⋯ In order to meet the present challenge, neurosurgeons must broaden our vision, our role, and our future educational goals. In this review, we summarize the landmark advances in the basic and clinical neurosciences and the results of clinical trials that are driving our evolution from passive reaction to disease to active attempts to restore lost central nervous system function.