Neurosurgery
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To elucidate the relationships between the neurovascular structures and surrounding bone, which are hidden from the surgeon by soft tissue, and to aid in avoiding nerve root and vertebral artery injury in anterior cervical spine surgery. ⋯ Although avoiding unfortunate injury is not always possible, understanding the locations and relations among the anatomic features is the only safeguard against unwarranted damage.
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Cranioplasty using acrylic is a common procedure in patients with cranial defects secondary to trauma, infection, or tumor. The limitations of this technique include poor adherence of the acrylic to surrounding bone and difficulty in achieving a proper cosmetic contour in complicated cranial defects, especially those involving the orbital rim. The authors have been continually developing techniques of cranioplasty. ⋯ All patients achieved excellent cosmetic results with no complications. This technique allows contour of the repair site while the acrylic is curing and provides a more resilient resulting prosthesis.
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Computed tomographic data from 174 patients with acute subdural hematoma were analyzed statistically to identify parameters that could be evaluated independently of clinical and neurological status to estimate outcome. ⋯ Based on these data, indications for surgery could be assessed by means of video conferencing, i.e., without personal examination of the patients.
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Review Case Reports
Contralateral cerebellar hemorrhagic infarction after pterional craniotomy: report of five cases and review of the literature.
Five cases of cerebellar hemorrhagic infarction complicating pterional craniotomy are presented. Recognition of this rare complication may be delayed, with catastrophic consequences, because clinicians are unaware of the possibility. We suggest that the mechanism of this complication is dislocation of the dependent part of the cerebellum and venous obstruction causing hemorrhagic infarction. ⋯ The outcome depended on two variables: 1) the rate of development of hemorrhagic infarction and the associated complications and 2) the amount of time that elapsed before remedial action was taken. Two patients with the first signs of deterioration in the immediate postoperative period had the worst outcome; one died and the other remained severely disabled. In two patients with good neurological recovery, problems were identified and corrected within 4 hours of the first sign of deterioration. Rapid overdrainage of cerebrospinal fluid during supratentorial surgery should be avoided, and the fluid volume should be replaced before closure. Postoperative evaluation of patients whose conditions deteriorate after supratentorial craniotomy should include adequate imaging studies of the posterior fossa.
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We describe the clinical application and utility of high-resolution magnetic resonance neurography (MRN) techniques to image the normal fascicular structure of peripheral nerves and its distortion by mass lesions or trauma in the lower extremity. ⋯ MRN proved useful in the preoperative evaluation and planning of surgery in patients with peripheral nerve lesions.