World Neurosurg
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The quality of life and functional outcome may be significantly impaired in patients of aneurysmal subarachnoid hemorrhage. The purpose of the present study was to assess the status of patients undergoing surgical clipping of intracranial aneurysms in a long-term follow-up and to identify factors affecting outcome. ⋯ Most patients who survived and were discharged continued to improve in the postoperative period even though the immediate postoperative outcome was not favorable in many. However, a substantial subset had impaired cognitive function.
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Comparative Study
Identification of knowledge gaps in neurosurgery through analysis of responses to the Self-Assessment in Neurological Surgery (SANS).
To examine the gaps in knowledge of neurosurgeons responding to the Self-Assessment in Neurological Surgery (SANS). ⋯ SANS demonstrated areas of knowledge gaps in a broad group of neurosurgeons. There were also significant differences between residents and attending neurosurgeons. Identification of areas of deficiency could prove useful in future educational endeavors.
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Few reports have addressed long-term outcomes, as well as the safety and efficacy of the cervical microendoscopic foraminotomy (CMEF) and cervical microendoscopic diskectomy (CMED) procedures used in modern spine practice to treat degenerative disease of the cervical spine. Accordingly, we present long-term outcomes from a cohort of patients treated for foraminal stenosis or disk herniation with the CMEF or CMED procedure, respectively. ⋯ Posterior CMEF and CMED are safe and effective procedures for minimally invasive decompression in the cervical spine.
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We analyzed consecutive subarachnoid hemorrhage (SAH) cases in patients older than 70 years of age who underwent aneurysm surgery. We report the influence of early ambulation on outcome in advanced-age SAH. ⋯ Elderly SAH patients with good Hunt-Hess grades should have a clip ligation or endovascular coiling. Early ambulation produces favorable outcome and a nondemential state in elderly SAH patients.
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Case Reports Comparative Study
Comparative analysis of the transcranial "far lateral" and endoscopic endonasal "far medial" approaches: surgical anatomy and clinical illustration.
The main aim of our study was to analyze and compare the surgical anatomy pertinent to the dorsal transcranial transcondylar (far lateral approach) with that of the ventral endoscopic endonasal transcondylar (far medial approach) route. ⋯ The far medial approach offers a safe, wide exposure of the lower third of the clivus for lesions that expand ventromedial to the hypoglossal nerve. The far lateral approach is most suitable for lesions located dorsolateral to the lower cranial nerves. The vertebral artery and hypoglossal canal are the most important landmarks to guide surgical planning. A combined endonasal-transcranial approach should be considered for resection of extensive lesions involving both ventromedial and dorsolateral compartments. We strive to encourage skull base surgeons to integrate endoscopic and microscopic approaches to the posterior fossa.