Neurosurgery
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In some patients with moyamoya disease, the development of spontaneous leptomeningeal collateral channels between the anterior cerebral artery (ACA) and other major arteries is poor. These patients require revascularization not only to the territory of the middle cerebral artery (MCA) but also to that of the ACA. For reliable revascularization to the ACA territory, we performed superficial temporal artery (STA)-ACA direct anastomosis in 5 of 58 patients with moyamoya disease who underwent cerebral revascularization at our institute during the last 8 years. ⋯ Our method using a cortical branch of the ACA as a recipient and a branch of the STA for the interposed graft can be performed at the convexity and much more easily than in a deep operative field. Our experience with STA-ACA anastomosis indicates that this procedure is effective for revascularization of the ACA territory in patients with moyamoya disease.
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Clinical strategy to maximize effectiveness and to minimize adverse influences remains to be determined for mild hypothermia therapy for traumatic brain injury. This study was conducted to evaluate the clinical feasibility of the titration method of mild hypothermia in severely head-injured patients in whom a reduction in intracranial pressure was regarded as the target effect. ⋯ The titration method of mild hypothermia to control intracranial hypertension in severely head-injured patients is clinically feasible. However, the method failed to reduce the incidence of infectious and hematological complications.
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To determine the selection factors for and results of second resections performed to treat recurrent glioblastoma multiforme (GM), we studied 301 patients with GM who were treated from the time of diagnosis using two prospective clinical protocols. ⋯ Survival after resection of recurrent GM remains poor despite advances in imaging, operative technique, and adjuvant therapies. High-quality survival after resection of recurrence to treat GM seems to have increased significantly since an earlier report from our institution.
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The advent of the microscope in the operating room revolutionized neurosurgery. We traced the origin and evolution of this important invention from the first magnifying lens to its practical application in neurosurgery. The concept of magnification evolved from unexplained observations in ancient times to the invention of the microscope by the late 16th century. ⋯ By the early 20th century, otolaryngologists became the first surgeons to use the microscope in clinical surgery. After World War II, ophthalmologists and vascular and plastic surgeons began using the microscope in the operating room, making further technical improvements. It was a relatively small group of pioneering neurosurgeons in the late 1950s and 1960s who transformed microneurosurgery from a revolutionary and unorthodox "experiment" into the standard of care in much of modern neurosurgery.
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To examine the relationship of the clinoid segment of the internal carotid artery to the structures in the roof of the cavernous sinus and to determine whether this segment is neither intradural nor intracavernous, as recently proposed. ⋯ The clinoid segment is intracavernous, being located within a collar of dura in which venous tributaries of the cavernous sinus course. The implications of these findings for surgery are reviewed.