Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Jul 1998
ReviewImaging of intracranial aneurysms and subarachnoid hemorrhage.
Advances in CT, MR imaging, and catheter angiography provide the radiologist and neurosurgeon with a variety of imaging options for screening, diagnosis, presurgical evaluation, and postoperative monitoring of patients with intracranial aneurysms. Noninvasive imaging techniques have not replaced conventional angiography for the comprehensive evaluation o aneurysms but are effective in screening patients suspected to have an unruptured aneurysm or for preoperative planning in emergency situations that preclude catheter angiography. ⋯ Rotational and intraoperative angiography are problem-solving options used for selected cases at our institution. Continuous improvements in techniques for CT and MR angiography may someday reach the point where surgery can be undertaken on the basis on noninvasive imaging alone, with catheter angiography reserved for endovascular therapy planning and guidance.
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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. · Apr 1998
Historical ArticleThe history of surgery for movement disorders.
Treatment of movement disorders by interruption of pathways within the nervous system has been a goal of neurosurgeons for the past century. When human stereotactic surgery was introduced 50 years ago, a major advance was made in surgical treatment of Parkinson's disease and other disorders of the motor system. Since then, the field has experienced a period of progressive growth, then abrupt decline, and now is more active than ever before and continuing to grow rapidly. Recent progress in computer science, imaging techniques, neurophysiology, and stereotactic targeting has provided the fuel for future progress.
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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.