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    ABSTRACT: Venous thromboembolism (VTE) is a recognized source of morbidity and mortality in patients suffering traumatic brain injury (TBI). While traumatic brain injury is a recognized risk factor for the development of VTE, its presence complicates the decision to begin anticoagulation due to fear of exacerbating the intracranial hemorrhagic injury. The role of chemoprophylaxis in this setting is poorly defined, leading to a wide variability in clinical practice. A comprehensive review of the literature was performed in an effort to summarize relevant data and construct a chemoprophylaxis protocol to be implemented in a Level I Trauma Center. The review reveals robust evidence regarding the safety and efficacy of chemoprophylaxis in the setting of TBI following demonstration of a stable intracranial injury. In light of this data, a protocol is assembled that, in the absence of predetermined exclusion criteria, will initiate chemoprophylaxis within 24 h after the demonstration of a stable intracranial injury by computed tomography (CT).
    Clinical Neurology and Neurosurgery 08/2014; 123:109–116. DOI:10.1016/j.clineuro.2014.05.017
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    ABSTRACT: This article reviews essential neurointerventional tools approved in the United States, including catheters and wires, coils, flow diverters, balloons, stents, and devices for mechanical thrombectomy and thrombolysis. These devices are the result of decades of technical development; this article will also briefly trace the evolution of these devices, with an emphasis on the most influential developments.
    Neurosurgery Clinics of North America 07/2014; DOI:10.1016/j.nec.2014.04.001
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    ABSTRACT: Two medications are licensed in the United States for the treatment of infection with genital herpes simplex virus (HSV): valacyclovir (approved by the Food and Drug Administration in 1995) and famciclovir (approved in 1997). All studied and licensed drugs for HSV infections assessed to date are selective inhibitors of HSV DNA polymerase and act as analogues of nucleoside triphosphate.(1) The report by Wald and colleagues in this issue of the Journal(2) introduces two fundamentally new approaches to the study of medications for the treatment of genital herpes. One approach involves the application of daily quantitative polymerase-chain-reaction (PCR) analysis to define ...
    New England Journal of Medicine 01/2014; 370(3):273-4. DOI:10.1056/NEJMe1313982
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    ABSTRACT: The giants of medicine and anatomy have each left their mark on the history of the cranial nerves, and much of the history of anatomic study can be viewed through the lens of how the cranial nerves were identified and named. A comprehensive literature review on the classification of the cranial names was performed. The identification of the cranial nerves began with Galen in the 2nd century AD and evolved up through the mid-20th century. In 1778, Samuel Sömmerring, a German anatomist, classified the 12 cranial nerves as we recognize them today. This review expands on the excellent investigations of Flamm, Shaw, and Simon et al., with discussion of the historical identification as well as the process of naming the human cranial nerves. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.
    Clinical Anatomy 01/2014; 27(1). DOI:10.1002/ca.22345
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    ABSTRACT: Recalcitrant trigeminal neuralgia following surgical treatment can be a life-altering condition. To explore alternative anatomic reasons for such a complication, the authors examined the potential for nerve connections between the sensory and motor roots of the trigeminal nerve at the opening of Meckel's cave (porus trigeminus). In 15 embalmed adult cadavers (30 sides), the authors performed microdissection of the skull base and specifically at the opening of Meckel's cave. Two sides (6.67%) were found to have interneural connections between the sensory and motor roots at Meckel's cave. These occurred in one male and one female cadaver, both on right sides. Both connections were histologically verified to be neural and were 0.5 mm in diameter and 2.2 and 3.2 mm in length, respectively. Both connections traveled in an oblique fashion from the portio major to the portio minor. On the basis of authors' findings, the sensory and motor components of the trigeminal nerve at the opening of Meckel's cave may be interconnected with a neural anastomosis. Such findings may be of use during the surgical treatment of trigeminal neuralgia or other surgery of the posterior fossa so that inadvertent transection or traction does not occur. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.
    Clinical Anatomy 01/2014; 27(1). DOI:10.1002/ca.22299
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    ABSTRACT: The relationship between the optic apparatus and the skull base is important during approaches near the sella turcica. One relationship that dictates which approach is taken is whether the optic chiasm is prefixed or postfixed or in a "normal" location, (centered over the diaphragma sella). The relationship between the position of the chiasm and the angulation of the pituitary stalk has not been investigated. Forty adult cadavers without intracranial pathology were dissected and parasagitally hemisected lateral to the sella turcica. The angulations between the pre- and postfixed and normal chiasm and the pituitary stalk were evaluated under magnification. Additionally, 50 MRIs performed among patients evaluating headache were analyzed for these relationships. For cadavers, the chiasm was prefixed in 7.5 % (n = 3), normal in 85 % (n = 34), and postfixed in 7.5 % (n = 3). On imaging, the chiasm was prefixed in 4 % (n = 2), normal in 88 % (n = 44), and postfixed in 8 % (n = 4). For all, the relation between the type of chiasm and the pituitary stalk was more often (p < 0.05) 90° or greater for prefixed chiasmata and acute angles for normal or postfixed chiasmata. These data may assist skull base surgeons when approaching pathology near the optic chiasm and pituitary stalk.
    Acta Neurochirurgica 11/2013; 156(1). DOI:10.1007/s00701-013-1944-1
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    ABSTRACT: The role of the choroid plexus in cerebrospinal fluid production has been identified for more than a century. Over the years, more intensive studies of this structure has lead to a better understanding of the functions, including brain immunity, protection, absorption, and many others. Here, we review the macro- and microanatomical structure of the choroid plexus in addition to its function and embryology. The literature was searched for articles and textbooks for data related to the history, anatomy, physiology, histology, embryology, potential functions, and surgical implications of the choroid plexus. All were gathered and summarized comprehensively. We summarize the literature regarding the choroid plexus and its surgical implications.
    Child s Nervous System 11/2013; 30(2). DOI:10.1007/s00381-013-2326-y
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    ABSTRACT: Yubitsumeis the ritualistic self-amputation of the proximal digits at the distal interphalangeal joint (DIP) among members of the Japanese mafia, or yakuza. This practice of self-mutilation is done as a sign of apology for making a mistake deemed punishable by higher-ranking members or violating the code of the yakuza. Members of the yakuza may present to emergency departments seeking medical assistance to stop hemorrhage following self-amputation or to have the severed portion of the injured finger reattached. 2013 KUMS, All rights reserved.
    Journal of injury & violence research 11/2013; DOI:10.5249/jivr.v6i2.489
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    ABSTRACT: Object Tectal plate gliomas are generally low-grade astrocytomas with favorable prognosis, and observation of the lesion and management of hydrocephalus remain the mainstay of treatment. Methods A cohort of patients with tectal plate gliomas at 2 academic institutions was retrospectively reviewed. Results Forty-four patients with a mean age of 10.2 years who harbored tectal plate gliomas were included in the study. The mean clinical and radiological follow-up was 7.6 ± 3.3 years (median 7.9 years, range 1.5-14.7 years) and 6.5 ± 3.1 years (median 6.5 years, range 1.1-14.7 years), respectively. The most frequent intervention was CSF diversion (81.8% of patients) followed by biopsy (11.4%), radiotherapy (4.5%), chemotherapy (4.5%), and resection (2.3%). On MR imaging tectal plate gliomas most commonly showed T1-weighted isointensity (71.4%), T2-weighted hyperintensity (88.1%), and rarely enhanced (19%). The initial mean volume was 1.6 ± 2.2 cm(3) and it increased to 2.0 ± 4.4 cm(3) (p = 0.628) at the last follow-up. Frontal and occipital horn ratio (FOHR) and third ventricular width statistically decreased over time (p < 0.001 and p < 0.05, respectively). Conclusions The authors' results support existing evidence that tectal plate gliomas frequently follow a benign clinical and radiographic course and rarely require any intervention beyond management of associated hydrocephalus.
    Journal of Neurosurgery Pediatrics 11/2013; 13(1). DOI:10.3171/2013.9.PEDS13347
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    ABSTRACT: Alfred W. Adson was a pioneer in the field of neurosurgery. He described operations for a variety of neurosurgical diseases and developed surgical instruments. Under his leadership the Section of Neurological Surgery at the Mayo Clinic was established and he functioned as its first chair. Adson's contributions to the understanding of spinal and spinal cord tumors are less well known. This article reviews related medical records and publications and sets his contributions in the context of the work of other important pioneers in spinal tumor surgery at the time.
    Journal of neurosurgery. Spine 10/2013; 19(6). DOI:10.3171/2013.9.SPINE13220
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