Neurosurgery
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The goal of this study was to document the influence of the treatment method (early surgery versus early endovascular treatment) on the development of chronic shunt-dependent hydrocephalus in a series of 242 patients treated within 7 days after aneurysmal subarachnoid hemorrhage (SAH). ⋯ The results of the present study indicate that the treatment method used does not affect the risk of the later development of chronic shunt-dependent hydrocephalus (early surgery, 23.2% [29 of 125]; early endovascular treatment, 17.7% [11 of 62]; P = 0.45).
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The goal of this study was to determine whether patients with "pure" epidural hematomas can now be transferred safely to a neurosurgical unit for decompression or whether general or orthopedic surgeons must still be prepared to perform emergency craniotomies. ⋯ Patients with pure epidural hematomas have better prognoses than previously assumed. There is usually enough time to safely transfer patients to a neurosurgical unit, provided that transport is rapid and anesthesiological services are available during the transport. Surgeons without training in neurosurgery should not perform emergency craniotomies in local hospitals but, rather, should transfer patients as quickly as possible to the nearest department of neurosurgery.
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Intramedullary spinal cord tumors are generally operated on by using the posterior approach. However, the posterior approach may not be suitable for a tumor in the anterior part of the spinal cord. In this report, we describe a case of a cervical intramedullary tumor that was successfully removed by using the anterior approach. ⋯ The present case suggests that the anterior approach is an important option among surgical approaches to the intramedullary tumor in cases in which the tumors are small in size and are located in the anterior part of the cervical cord.
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To examine in a prospective manner the long-term safety and efficacy of chronic intrathecal morphine in patients with severe, nonmalignant pain refractory to less invasive modalities. ⋯ Continuous intrathecal morphine can be a safe, effective therapy for the management of severe, nonmalignant pain among a carefully selected patient population and can result in long-term improvement in several areas of daily function.
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To evaluate the possible role of the antioxidant ebselen in the treatment of cerebral vasospasm, we examined the effects of ebselen on the vasoactive mechanisms induced by endothelin (ET)-1, oxyhemoglobin, and oxygen-derived radicals. ⋯ Ebselen suppressed ET-1-induced contraction and synergetic interaction between oxyhemoglobin and ET-1, where free radical formation was involved. These effects may result from modification of the intracellular regulatory system including protein kinase C, as well as from protection against free radicals.