Neurosurgery clinics of North America
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Hypothermia has long been recognized as an effective therapy for acute neurologic injury. Recent advances in bedside technology and greater understanding of thermoregulatory mechanisms have made this therapy readily available at the bedside. ⋯ At present, hypothermia has only been shown to be an effective neuroprotective therapy in cardiac arrest survivors. The primary use of hypothermia in the neurocritical care unit is to treat increased intracranial pressure.
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The cause of seizures in the neurosurgical intensive care unit (NICU) can be categorized as emanating from either a primary brain pathology or from physiologic derangements of critical care illness. Patients are typically treated with parenteral antiepileptic drugs. ⋯ Late seizures have a more ominous risk for subsequent epilepsy and should be treated for extended periods of time or indefinitely. This review ends by examining the treatment algorithms for simple seizures and status epilepticus and the role newer antiepileptic use can play in the NICU.
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Neurosurg. Clin. N. Am. · Apr 2013
Review Case ReportsUse of Surgimap Spine in sagittal plane analysis, osteotomy planning, and correction calculation.
Over the past 3 decades the sagittal plane has received increasing attention from the scientific community and spine surgeons alike. There remains a lack of clear and concise methods for incorporating surgical techniques and radiographic parameters to achieve the best possible outcome on a patient-specific level. This article proposes a new method for a treatment approach to sagittal malalignment by incorporating new digital tools for surgical planning. This technique offers a consistent approach to adult spinal deformity with sagittal-plane components, and can permit optimization in consistently achieving proper postoperative spinopelvic alignment.
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The goal of any ambulatory patient is to maintain a horizontal gaze with the least amount of energy expenditure. With progressive deformity, and in particular sagittal malalignment, significant compensatory mechanisms must be used to achieve this goal. ⋯ The pelvis may compensate for decreasing lumbar lordosis (eg, age, flat back deformity) by retroverting and increasing pelvic tilt and decreasing the sacral slope. Underappreciation for these spinopelvic compensatory mechanisms leads to surgical under-correction, iatrogenic flat back and poor clinical outcomes.
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Various osteotomies are useful in making a rigid deformity flexible enough for realignment in coronal and sagittal plane. This article defines the osteotomies and their usefulness in treatment of specific rigid deformities. The pedicle subtraction osteotomy and vertebral column resection used in treating rigid deformities are described in detail.