Acta neurochirurgica
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Acta neurochirurgica · Dec 2002
Case ReportsImpact of brain shift on intraoperative neurophysiological monitoring with cortical strip electrodes.
Intraoperative neurophysiological monitoring has become the standard procedure for locating eloquent regions of the brain. Such continuous electrical stimulation of motor pathways is usually applied by means of flat silicon-embedded electrodes placed directly on the motor cortex. However, shifting of the silicon strip on the cortical surface as well as electrode displacement due to brain shift underneath the electrode can lead to inaccurate recordings not directly caused by intraoperative impairment of the motor cortex or the motor pathways. ⋯ Changes in the location of cerebral structures due to intraoperative brain shift may exert a marked influence on intraoperative neurophysiological monitoring if cortical strip electrodes are used. Therefore, long-term monitoring of the central region requires continuous checking of the position of stimulating electrodes and, if necessary, correction of their location.
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Acta neurochirurgica · Dec 2002
The microsurgical anatomy of the cisternal segment of the trochlear nerve, as seen through different neurosurgical operative windows.
To describe the anatomy of the cisternal segment of the trochlear nerve as seen through different neurosurgical approaches. ⋯ The trochlear nerve is a very delicate structure that can be easily injured during approaches to the tentorial incisura. Accurate knowledge of its anatomy as seen through different operative windows is helpful in maintaining its integrity during surgery.
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Acta neurochirurgica · Dec 2002
Epidemiological, forensic, clinical, and imaging characteristics of head injuries acquired in the suicide attempt with captive bolt gun.
The captive bolt gun (slaughterer's gun) is a tool used in the meat industry for "humane killing" of animals. Used with the intent of suicide, the captive bolt gun causes very serious injuries. We analysed 19 self-inflicted head injuries with captive bolt gun during the past 20 years. ⋯ The clinical appearance of the entrance wound and the imaging characteristics of the cranial trauma are very specific, and can be easily differentiated from firearm or other penetrating injuries. These wounds were always primarily infected with mixed bacterial flora from the skin. Therefore, besides radical primary wound care, especially of the wound canal with removal of foreign bodies, it is important to administer high doses of wide spectrum antibiotics.
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Acta neurochirurgica · Nov 2002
Case ReportsCranioplasty with individual carbon fibre reinforced polymere (CFRP) medical grade implants based on CAD/CAM technique.
The authors present a new method for the reconstruction of large or complex-formed cranial bone defects using prefabricated, computer-generated, individual CFRP (carbon fibre reinforced plastics) medical grade implants. ⋯ Individual, prefabricated CFRP medical grade implants may be considered as an alternative to conventionally utilised materials for cranioplasty, in particular in the challenging group of patients with extensive cranial defects or more complex-formed defects of the fronto-orbital or temporo-zygomatic region, guaranteeing short operating times and excellent functional and aesthetic results, which justifies the expense of their production.
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Acta neurochirurgica · Nov 2002
Atlantoaxial screw fixation for the treatment of isolated and combined unstable jefferson fractures - experiences with 8 patients.
The unstable atlas burst fracture ("Jefferson fracture") is a fracture of the anterior and posterior atlantal arch with rupture of the transverse atlantal ligament and an incongruence of the atlanto-occipital and the atlanto-axial joint facets. The question whether it has to be treated surgically or nonsurgically is still discussed and remains controversial. During the last decade 8 patients with unstable atlas burst fractures were examined and treated in our department. ⋯ Nonsurgical treatment with halo extension always bears the risk of insufficient healing with further instability and a fixated incongruence of the atlanto-occipital and the atlanto-axial joints, leading to arthrosis, immobility and increasing neck pain. After 10 weeks of insufficient immobilization secondary pre- and intra-operative reposition manoeuvres and surgical fixation hardly can reverse this fixated incongruence. Moreover, halo-extension needs an immobilization of the cervical spine for about 10 weeks and more, which is very uncomfortable and leads to further complications especially in elderly patients.