Journal of neurosurgery
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Journal of neurosurgery · May 2000
Telovelar approach to the fourth ventricle: microsurgical anatomy.
In the past, access to the fourth ventricle was obtained by splitting the vermis or removing part of the cerebellum. The purpose of this study was to examine the access to the fourth ventricle achieved by opening the tela choroidea and inferior medullary velum, the two thin sheets of tissue that form the lower half of the roof of the fourth ventricle, without incising or removing part of the cerebellum. ⋯ Gently displacing the tonsils laterally exposes both the tela choroidea and the inferior medullary velum. Opening the tela provides access to the floor and body of the ventricle from the aqueduct to the obex. The additional opening of the velum provides access to the superior half of the roof of the ventricle, the fastigium, and the superolateral recess. Elevating the tonsillar surface away from the posterolateral medulla exposes the tela, which covers the lateral recess, and opening this tela exposes the structure forming the walls of the lateral recess.
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Journal of neurosurgery · May 2000
Randomized Controlled Trial Comparative Study Clinical TrialEfficacy of the Ghajar Guide revisited: a prospective study.
The goal of this study was to compare the freehand technique of catheter placement using external landmarks with the technique of using the Ghajar Guide for this procedure. The placement of a ventricular catheter can be a lifesaving procedure, and it is commonly performed by all neurosurgeons. Various methods have been described to cannulate the ventricular system, including the modified Friedman tunnel technique in which a soft polymeric tube is inserted through a burr hole. Paramore, et al., have noted that two thirds of noninfectious complications have been related to incorrect positioning of the catheter. ⋯ Successful cannulation was achieved using either technique; however, the catheters placed using the Ghajar Guide were closer to the target.
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Journal of neurosurgery · May 2000
Quantitative description of the far-lateral transcondylar transtubercular approach to the foramen magnum and clivus.
The purpose of this study was to evaluate the far-lateral transcondylar transtubercular approach (complete FLA) based on quantitative measurements of the exposure of the foramen magnum and petroclival area obtained after each successive step of this approach. ⋯ The complete FLA provides wide and sufficient exposure of the foramen magnum and lower to middle clivus. The complete FLA consists of several steps, each of which contributes to increasing petroclival exposure and surgical freedom. However, the FLA may be limited to the less aggressive steps, while still achieving significant exposure and surgical freedom. The choice of complete or basic FLA thus depends on the underlying pathological condition and the degree of exposure required for effective surgical treatment.
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Journal of neurosurgery · May 2000
Significant reduction in brain swelling by administration of nonpeptide kinin B2 receptor antagonist LF 16-0687Ms after controlled cortical impact injury in rats.
Identification of new therapeutic agents aimed at attenuating posttraumatic brain edema formation remains an unresolved challenge. Among others, activation of bradykinin B2 receptors is known to mediate the formation of brain edema. The purpose of this study was to investigate the protective effect of the novel nonpeptide B2 receptor antagonist, LF 16-0687Ms, in brain-injured rats. ⋯ Using the present study design, a single administration of LF 16-0687Ms successfully reduced posttraumatic brain swelling. The decreased levels of taurine, hypoxanthine, and xanthine may reflect reduced posttraumatic brain edema, whereas the increased level of glutamate could account for the elevated water content observed in the nontraumatized hemisphere.