Acta neurochirurgica
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Acta neurochirurgica · Oct 2010
Slow vasogenic fluctuations of intracranial pressure and cerebral near infrared spectroscopy--an observational study.
Increased slow-wave activity in intracranial pressure (ICP) signifies an exhausted cerebrospinal compensatory reserve across a range of conditions. In this study, we attempted to describe synchronisation between slow waves of ICP and of near-infrared spectroscopy (NIRS) variables during controlled elevation of ICP. ⋯ Slow fluctuations in cerebral oximetry as detected by NIRS coincide with and are implicated in the origin of ICP slow waves and increases during periods of exhausted cerebrospinal compensatory reserve. NIRS may be used as a non-invasive marker of increased ICP slow waves (and therefore reduced CSF compensatory reserve).
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Acta neurochirurgica · Oct 2010
Intramedullary high signal intensity and neurological status as prognostic factors in cervical spondylotic myelopathy.
The neurological outcome of cervical spondylotic myelopathy (CSM) may depend on multiple factors, including age, symptom duration, cord compression ratio, cervical curvature, canal stenosis, and factors related to magnetic resonance (MR) signal intensity (SI). Each factor may act independently or interactively with others. To clarify the factors in prognosis, we prospectively analyzed the outcomes of patients with myelopathy caused by soft disc herniation in correlation with magnetic resonance imaging (MRI) findings and other clinical parameters. ⋯ Among the variables tested, preoperative neurological status and intramedullary signal intensity were significantly related to neurological outcome. The better the preoperative neurological status was, the better the post-operative neurological outcome. The SI grade on the preoperative T2WI was negatively related to neurological outcome. Hence, the severity of SI change and preoperative neurological status emerged as significant prognostic factors in post-operative CSM.
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Acta neurochirurgica · Oct 2010
Training in endoscopic endonasal transsphenoidal surgery using a skull model and eggs.
Recently, endoscopic pituitary surgery is increasingly being used in pituitary surgery. Compared to conventional microscopic pituitary surgery, outcomes have been non-inferior, so endoscopic pituitary surgery has become an established surgical technique. However, this is a highly specialized surgery and sophisticated surgical techniques are required. We report our development of a training model for endoscopic endonasal transsphenoidal surgery. ⋯ This training model using a skull model and eggs is useful to improve surgical techniques in endoscopic endonasal transsphenoidal surgery.
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Acta neurochirurgica · Sep 2010
Case ReportsAdenocarcinoma of the prostate involving the lumbosacral plexus: MRI evidence to support direct perineural spread.
Prostate adenocarcinoma, which may recur despite aggressive treatment, has the potential to spread to the lumbosacral plexus. This intraneural involvement is not widely known and is thought to be from direct perineural spread. We hypothesized that high-resolution imaging could provide supportive evidence for this mechanism. ⋯ The potential for prostate adenocarcinoma to spread to the lumbosacral plexus has, to our knowledge, not been readily appreciated. Because the imaging findings are often subtle, we believe that intraneural lumbosacral plexus involvement may not be uncommon. This study, with the use of high-resolution MRI and PET/CT studies, supports the direct perineural spread of prostate adenocarcinoma via the pelvic plexus to the lumbosacral plexus. This mechanism could also explain cases of leptomeningeal and/or dural-based prostate metastases.
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Acta neurochirurgica · Sep 2010
Procedural predictors of delayed cerebral infarction after intra-arterial vasodilator infusion for vasospasm following aneurysmal subarachnoid hemorrhage.
The goals of this study were to identify predictors of delayed cerebral infarction in aneurysmal SAH after intra-arterial (IA) vasodilator infusion and to select proper parameters for treatment success. ⋯ Angiographic CCT and residual narrowing at the end of IA vasodilator infusion were found to predict the subsequent occurrence of cerebral infarction. The authors suggest that residual narrowing of 30% and a CCT of 7 s could be used as a minimum indicator of IA vasodilator infusion endpoints.