Neurosurgery clinics of North America
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Rupture of cerebral aneurysms is a complex and devastating pathophysiologic event. The successful management of aneurysm rupture requires a dedicated multidisciplinary team. This article reviews pathophysiology; clinical grading that can be used to predict outcome and guide therapy; factors that may affect outcome such as rebleeding, poor clinical grade, intracerebral hemorrhage, intraventricular hemorrhage, and acute hydrocephalus; preoperative care and assessment; pharmacological therapy; anesthetic, surgical, and endovascular considerations; and postoperative care following aneurysm rupture.
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Surgical treatment of Parkinson's disease has become an important mode of therapy for advanced disease. Both ablative lesions and, more recently, deep brain stimulation have been employed. Various brain areas, including the thalamus, globus pallidus, and subthalamus, have been target sites.
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Neurosurg. Clin. N. Am. · Jan 1998
ReviewAnesthetic considerations in neonatal neurosurgical patients.
Neonatal neurosurgery patients have specific considerations throughout the perioperative course in addition to the usual care of neonates undergoing other surgical procedures. Prematurity, with its associated comorbidity, temperature, and glucose control are important topics to consider in this age group. This article addresses practical aspects of preoperative assessment, intraoperative management, and postoperative care. Because CSF shunting and myelomeningocele repair are common neonatal procedures, these specific procedures are the focus of this article.
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Current improvements in radiologic imaging and surgical instrumentation have greatly expanded the role of surgery in management of tumors of the thoracolumbar junction. For primary malignant tumors, the aim of surgery should be curative, with eradiction of all gross disease. For metastatic tumors, indications for surgery include cancer therapy, stabilization, neurologic palliation, tissue diagnosis, and pain relief. Because the thoracolumbar region is a transitional zone, surgical stabilization may require anterior-posterior approaches and instrumentation.
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Neurosurg. Clin. N. Am. · Oct 1997
ReviewClassification and acute management of thoracolumbar fractures.
Successful management of traumatic injuries of the thoracolumbar spine requires understanding of the concepts of spinal stability and instability. There are numerous classifications of injury patterns based on fracture type and the probable forces involved. This article focuses on Denis's three-column theory of spinal stability and its utility in categorizing five injury patterns and the forces involved: specifically, wedge compression fractures, burst fractures, flexion distraction injuries, fracture dislocations, and miscellaneous injuries. The authors also highlight the acute management and evaluation of patients suspected to have these types of injuries.