Neurosurg Focus
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Baclofen pump infusion systems are used for the treatment of patients with severe spasticity. When symptoms do not respond to infusion rate increases, the cause may be pump malfunction or catheter obstruction. The purpose of this investigation was to review the authors' experience with indium-111 diethylene-triamine-pentaacetic acid (In-111 DTPA) scintigraphy for evaluation of baclofen infusion system function and patency and to correlate scintigraphic findings with patient treatment and outcome to determine optimal methodology and diagnostic criteria. ⋯ The use of In-111 DTPA scintigraphy of intrathecal baclofen infusion systems can play an important role in determining the functional status of these systems and guiding subsequent patient care.
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Antibiotic-impregnated shunt (AIS) systems may decrease the incidence of cerebrospinal fluid (CSF) shunt infections. However, there is a reluctance to use AIS components because of their increased cost. In the present study the authors evaluated factors contributing to the medical costs associated with the treatment of CSF shunt infections in a hydrocephalic pediatric population, those implanted with AIS systems compared with those implanted with standard shunt systems. ⋯ Although individual AIS components are more expensive than standard ones, factors contributing to medical costs are fewer in pediatric patients with infected shunts when the components are antibiotic-impregnated rather than standard.
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Pancoast tumors are aggressive bronchogenic lesions of the lung apex that are rapidly fatal if untreated. Modern treatment includes induction chemotherapy and radiotherapy prior to resection, but many authors also resect the T-1 nerve root (with or without the C-8 nerve root and the lower trunk of the brachial plexus) as part of the therapy, causing significant loss of hand function in many patients. The current authors determined whether a different approach allowing preservation of the brachial plexus and hand function could be adopted without compromising patient survival. An extensive historical review of Pancoast tumors is presented as a baseline for clinical comparison. ⋯ Although this patient series is small, the findings are extremely encouraging and suggest that the described treatment paradigm preserves survival as well as hand function in patients with Pancoast tumors.
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Whole-brain radiotherapy (WBRT) after resection of a single brain metastasis can cause long-term radiation toxicity. The authors evaluated the efficacy of resection and placement of 125I seeds (without concomitant WBRT) for newly diagnosed single brain metastases. ⋯ Permanent 125I brachytherapy applied at the initial operation without WBRT provided excellent local tumor control. Local control and patient survival rates were at least as good as those reported for resection combined with WBRT. Although the authors noted a higher incidence of distant metastases compared with that reported in other studies of initial WBRT, these metastases were generally well controlled with a combination of surgery, stereotactic radiosurgery, and, less often, WBRT. Twenty-four patients (92%) never required WBRT, thus avoiding potential long-term radiation-induced neurotoxicity.
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Review Historical Article
Cervical spine surgery in the ancient and medieval worlds.
The early historical literature on cervical spine surgery lacks printed material for review, and we can rely only on pathological material from the prehistoric period that has survived as a result of anthropological investigations. After the introduction of Egyptian and early Hellenic medicine, some written material became available. This paper reviews these materials, from both books and manuscripts, in an effort to understand the development of cervical spine surgery from the perspectives of the personalities involved and the early surgical practices used. The review thus considers the following five eras of medicine: 1) prehistoric; 2) Egyptian and Babylonian; 3) Greek and early Byzantine; 4) Middle Eastern; and 5) medieval.