World Neurosurg
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Review Historical Article
Focused ultrasound: relevant history and prospects for the addition of mechanical energy to the neurosurgical armamentarium.
Although the concept of focused ultrasonography emerged more than 70 years ago, the need for a craniectomy obviated its development as a noninvasive technology. Since then advances in phased array transducers and magnetic resonance imaging technology have resurrected the ultrasound as a noninvasive therapeutic for a plethora of neurological conditions ranging from embolic stroke and intracranial hemorrhage to movement disorders and brain neoplasia. ⋯ In addition, focused ultrasound comes without the general complexity or the risks of ionizing radiation that accompany radiosurgery. As the quest for minimally invasive and noninvasive therapeutics continues to define the new neurosurgery, the focused ultrasound evolves to join the neurosurgical armamentarium.
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Bone flap infections after autogenous cranioplasty can present a diagnostic and management challenge. Little is known about the clinical, radiological, and microbiological profile of these patients. ⋯ Clinical assessment is critical to the diagnosis of bone-flap infection. A high index of suspicion is necessary because late presentations are possible. Empirical antimicrobial treatment should include gram-negative coverage.
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This study sought to characterize the utility of coregistered 11C-methionine positron emission tomography (MET-PET) with 3-T magnetic resonance imaging (3T MRI) in the diagnosis and follow-up of pituitary adenomas in patients with acromegaly and to compare MET-PET and 18F-fluorodeoxyglucose emission tomography (FDG-PET) for the evaluation of active or recurrent disease. ⋯ MET-PET is a sensitive technique for diagnosing persistent acromegaly, and its coregistration with 3T MRI has demonstrated a better definition of the interface, extension, and location of the lesion in the management of active postoperative acromegaly.
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To present a case of a traumatic fracture of a polymethyl methacrylate (PMMA) patient-specific implant (PSI) for cranioplasty. ⋯ PMMA PSIs are commonly used for large defects and generally have good outcomes with low rates of revision. The case report described involves a shattered PMMA PSI after a traumatic impact, which resulted in hemiparesis. The question arises if this type of complication can be easily avoided with the addition of titanium onlay to restrict displacement in the event of fracture. This onlay represents a minor change of technique that could prevent migration of fracture fragments.
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The aim of this study was to examine the solid bone fusion rates between Plasmapore-coated titanium cages (PPC group) and non-Plasmapore-coated titanium cages (N-PPC group) in patients who received anterior cervical decompression and fusion (ACDF). ⋯ Plasmapore-coated titanium cages enabled more rapid solid bone fusion. We suggest that these types of cages might help to reduce postoperative radiograms.