Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Apr 2003
ReviewSurgery for Parkinson's disease: lack of reliable clinical trial evidence.
There has been a striking resurgence of interest in surgery for Parkinson's disease (PD) with new targets identified and new procedures developed. This systematic review identified over 500 studies of surgery for PD published since 1990, including over 10 000 patients. ⋯ Studies of surgery for PD have generally been of poor quality with too few patients, too short follow up, inappropriate choice of outcome measures, and lack of control groups. Much larger, randomised, controlled trials are needed to assess the longer term effects of surgery on patient rated quality of life and cost effectiveness.
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J. Neurol. Neurosurg. Psychiatr. · Apr 2003
ReviewEffects of decompressive craniectomy on brain tissue oxygen in patients with intracranial hypertension.
This report examined the intraoperative course of partial pressure of brain tissue oxygen (P(ti)O(2)) and intracranial pressure (ICP) during surgical decompressive craniectomy for medically intractable intracranial hypertension due to diffuse brain swelling in three patients after severe subarachnoid haemorrhage and aneurysm coiling. The mean ICP decreased from 59 mm Hg to 10 mm Hg in a two step fashion, relating to bone flap removal and dural opening. ⋯ P(ti)O(2) and ICP remained at non-critical ranges postoperatively. Despite these beneficial effects on ICP and P(ti)O(2), the patients' clinical status remained poor with two in a persistent vegetative state and one dead.
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J. Neurol. Neurosurg. Psychiatr. · Apr 2003
Case ReportsBrain cysts associated with mutation in the Aristaless related homeobox gene, ARX.
The novel Aristaless related homeobox gene, ARX, is widely expressed in the brain and is thought to play a key role in the regulation of brain development. Neurological phenotypes caused by ARX mutations have recently started to unfold. ⋯ No retraction or expansion in neighbouring parenchyma was observed, there was no history of acute neurological impairment, and no risk factors for cerebrovascular disease were found. The lesions appeared to be congenital and represented benign developmental cysts, possibly caused by the ARX mutation.
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J. Neurol. Neurosurg. Psychiatr. · Apr 2003
Clinical TrialPreoperative motor system brain mapping using positron emission tomography and statistical parametric mapping: hints on cortical reorganisation.
This study investigated the applicability of statistical parametric mapping (SPM) for analysing individual preoperative brain mapping studies in patients with cerebral mass lesions for neurosurgical planning. The study further investigated if hints on functional reorganisation processes can be found. ⋯ It is concluded that SPM provides an efficient method for analysing individual preoperative PET activation studies. Activations of the ipsilateral premotor cortices and contralateral cerebellum may indicate an enhanced recruitment of ipsilateral motor pathways evoked by functional reorganisation processes. However, this changed activation pattern was not necessarily associated with a better neurological status.
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J. Neurol. Neurosurg. Psychiatr. · Apr 2003
Letter Case ReportsMultifocal myoclonus secondary to tranexamic acid.