Intraoperative navigation assisted placement of percutaneous pedicle screws.

Minimally invasive surgical (MIS) approaches are gaining popularity in many surgical fields. Potential advantages include reduced blood loss, shorter length of stay, and less soft-tissue trauma. Potential disadvantages include inadequate deformity correction, increased fluoroscopy, longer operative times, and decreased posterolateral fusion surface area exposure.

The emerging role of recombinant-activated factor VII in neurocritical care.

Recombinant-activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Denmark) was developed specifically for the management of bleeding in hemophiliacs with inhibitors to factors VIII or IX. Several recent case reports and small clinical studies also suggest that rFVIIa may be useful as a general hemostatic agent in nonhemophilic patients. The mechanism by which rFVIIa acts is controversial with both tissue factor-dependent and -independent mechanisms proposed.

Intracerebral hemorrhage: pathophysiology and therapy.

Spontaneous intracerebral hemorrhage, from several sources, causes instantaneous mass effect, disruption of surrounding brain, and often an early neurological death. If the patient survives the initial event, the hematoma can lead to secondary brain injury, neurological deficits, and, occasionally, delayed fatality. The mechanisms that trigger pathophysiological changes in and around the hematoma are becoming better understood, offering new therapeutic opportunities.

Spontaneous intracerebral hemorrhage: a review.

Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs.

Migration of distal ventriculoperitoneal shunt catheter into the heart. Case report and review of the literature.

Migration of distal ventriculoperitoneal shunt tubing is known to occur in a wide of variety of locations. The authors report an unusual complication involving a previously confirmed intraperitoneal shunt catheter that migrated into the heart and pulmonary vasculature. Radiographic evidence suggested that this occurred secondary to cannulation of a segment of the external jugular vein with a shunt trochar during tunneling of the distal catheter.

Recombinant activated factor VII for the rapid correction of coagulopathy in nonhemophilic neurosurgical patients.

Objective: Coagulopathy is a significant contraindication for neurosurgery. Unfortunately, many coagulopathic patients require urgent neurosurgical intervention. Standard use of blood products, including fresh-frozen plasma or prothrombin complexes, to correct the coagulopathy often leads to significant delays in treatment.