Acta neurochirurgica
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Acta neurochirurgica · Apr 2015
Case ReportsSubcortical language and non-language mapping in awake brain surgery: the use of multimodal tests.
Awake craniotomy is currently considered the gold standard to maximise the extent of resection and to minimise postoperative deficits in patients with supratentorial tumours near eloquent areas. In addition to direct electrical stimulation (DES) of the cortex, intraoperative subcortical mapping is increasingly used as it optimises the benefit-to-risk ratio by decreasing (permanent) postoperative neurological deficits. However, only little attention has been paid to subcortical mapping procedures and especially the tasks to be used. ⋯ Administration of multimodal tests during subcortical DES such as the experimental QMT may facilitate identification of eloquent pathways leading to avoidance of permanent neurological impairments.
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Acta neurochirurgica · Apr 2015
Higher impact energy in traumatic brain injury interferes with noncovalent and covalent bonds resulting in cytotoxic brain tissue edema as measured with computational simulation.
Cytotoxic brain tissue edema is a complicated secondary consequence of ischemic injury following cerebral diseases such as traumatic brain injury and stroke. To some extent the pathophysiological mechanisms are known, but far from completely. In this study, a hypothesis is proposed in which protein unfolding and perturbation of nucleotide structures participate in the development of cytotoxic edema following traumatic brain injury (TBI). ⋯ Based on the analysis of the numerical simulation data, the kinetic energy from an external dynamic impact has the theoretical potential to interfere not only with noncovalent, but also with covalent bonds when high enough. The subsequent attraction of increased water molecules into the unfolded protein structures and disruption of adenosine-triphosphate bonds could to some extent explain the etiology to cytotoxic edema.
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Acta neurochirurgica · Apr 2015
Results of nerve reconstructions in treatment of obstetrical brachial plexus injuries.
The aim of this study was to evaluate the results achieved using various surgical techniques in patients with partial and total obstetrical brachial plexus palsy. ⋯ Improved function can be obtained in infants with obstetrical brachial plexus injury with early surgical reconstruction.
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Acta neurochirurgica · Apr 2015
Guiding protractor for accurate freehand placement of ventricular catheter in ventriculoperitoneal shunting.
While frameless stereotaxis can be used for shunt ventricular catheter placement in patients with smaller ventricles, the ventricular catheter is still commonly placed based on the surface anatomy of the head for patients with larger ventricles. Thus, surgical techniques and guides facilitating accurate and reliable freehand placement of the ventricular catheter still need to be devised. ⋯ The proposed surgical technique using a guiding protractor facilitates accurate freehand placement of a ventricular catheter for patients with a bicaudate index >0.2 or bifrontal distance >25 mm.