Neurosurgery
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Review Comparative Study
Deep brain stimulation for intractable pain: a 15-year experience.
During the past 15 years, we prospectively followed 68 patients with chronic pain syndromes who underwent deep brain stimulation (DBS). The objective of our study was to analyze the long-term outcomes to clarify patient selection criteria for DBS. ⋯ DBS in selected patients provides long-term effective pain control with few side effects or complications.
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Comparative Study
Microsurgical results for small arteriovenous malformations accessible for radiosurgical or embolization treatment.
A consecutive series of microsurgically treated small arteriovenous malformations (AVMs), up to 3 cm in diameter, which are theoretically ideal candidates for radiosurgery or embolization, is described. We intended to elucidate the safety and efficacy of the microsurgical removal of AVMs, as compared with the results for radiosurgery and embolization reported in the literature. ⋯ Microsurgery for small AVMs is superior to radiosurgery or interventional neuroradiology because of its high rate of efficacy and low rate of permanent morbidity and because immediate cure of the AVMs can be achieved in the vast majority of patients. The place for radiosurgery in the treatment of small AVMs needs to be more sharply defined after careful assessment of relevant cases by an experienced vascular neurosurgeon.
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Case Reports
Biportal endoscopic management of third ventricle tumors in patients with occlusive hydrocephalus: technical note.
To present the feasibility and advantages of the biportal endoscopic management of posterior third ventricle tumors. As a result of recent developments in neuroendoscopy, classical third ventriculostomy has become a standard single burr hole procedure and a real alternative to shunting in the treatment of occlusive hydrocephalus. In patients with third ventricle tumors occluding the aqueduct, the acute development of hydrocephalus may often precede debilitating focal symptoms and signs. Forty percent of those tumors are radiosensitive, rendering craniotomy unnecessary. The goal of primary management is the alleviation of raised intracranial pressure and determination of the histological nature of the tumor. Cerebrospinal fluid shunting and the performance of a computed tomography- or magnetic resonance imaging-guided biopsy are generally suggested as the methods of choice. ⋯ The biportal endoscopic approach allowed independent visual control of both procedures, safe passages of the ventriculoscopes via the narrow foramen of Monro, and facile control of the intracranial pressure in the ventricles via the available four irrigation channels during the performance of tumor biopsy and fenestration of the floor of the third ventricle. In selected patients with infiltrating posterior third ventricle tumors, this procedure and postoperative radiotherapy may be an alternative to direct surgery or to shunting and performance of image-guided biopsy.
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Historical Article
Neurological surgery at New York University Medical Center.
New york university Medical Center underwent a complex evolution in a rapidly growing and dynamic city. Care for the hospital-based poor resulted in international preeminence in surgical techniques. Neurosurgery at New York University has also evolved to meet the demands of the Medical Center and the community. Developments in high technology surgery and telecommunications will provide an international resource and trainees who are prepared to face the challenges of practice in the next century.
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Neurological deterioration, typically attributed to cerebral edema, is a rare but life-threatening complication in the treatment of diabetic ketoacidosis (DKA). We report the case of a child with DKA who became comatose but demonstrated acute obstructive hydrocephalus, instead of cerebral edema. ⋯ These observations emphasize the importance of recognizing hydrocephalus as a potentially reversible cause of coma in DKA and of initiating prompt neurosurgical intervention, if warranted.