Journal of neurosurgery
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Journal of neurosurgery · Oct 2001
Monitoring of intraoperative motor evoked potentials to increase the safety of surgery in and around the motor cortex.
The repetitive application of high-frequency anodal monopolar stimulation during surgery in or near the motor cortex allows a qualitative and quantitative evaluation of motor evoked potentials (MEPs). Using this method, motor pathways and motor function can be continuously monitored during surgery. ⋯ Improved surgical safety can be achieved using intraoperative neurophysiological monitoring procedures. Repetitive stimulation of the motor cortex proved to be a reliable method for monitoring subcortical motor pathways. Changes in MEP latency and MEP amplitude served as warning criteria during surgery and possessed prognostic value.
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Journal of neurosurgery · Oct 2001
Population-based analysis of arteriovenous malformation treatment.
The author sought to describe overall management data on cerebral arteriovenous malformations (AVMs) and to focus the actuarial need for different treatment modalities on a population-based scale. Such data would seem important in the planning of regional or national multimodality strategies for the treatment of AVMs. This analysis of a nonselected, consecutive series of patients representing every diagnosed case of cerebral AVM in a population of 1,000,000 over one decade may serve to shed some light on these treatment aspects. ⋯ In centers with population-based referral, AVM of the brain is predominantly a disease related to intracranial bleeding. and parenchymal clots have a profound impact on overall management outcome. The rupture of an AVM is as devastating as that of an aneurysm. Aneurysm ruptures are more lethal, whereas AVM rupture tends to result in more neurological disability due to the high occurrence of lobar intracerebral hematoma. In an attempt to quantify the need for different modalities of AVM treatment based on a population of 1,000,000 people, figures for surgeries performed range from six to 10 operations per year and embolization as well as gamma knife surgery procedures range from two to seven per year, depending on the strategy at hand. When using nonsurgical approaches to Grade 1 to 3 lesions, the number of patients requiring treatment with more than one method for obliteration increases drastically as does the potential risk for procedure-related complications.
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Journal of neurosurgery · Oct 2001
Case ReportsThreshold-level repetitive transcranial electrical stimulation for intraoperative monitoring of central motor conduction.
The authors conducted a study to evaluate repetitive transcranial electrical stimulation (TES) to assess spinal cord motor tract function in individuals undergoing spine surgery, with emphasis on safety and efficacy. ⋯ Intraoperative threshold-level repetitive TES-based monitoring of central motor conduction has proven to be a simple, safe, and highly accurate technique for the prevention or minimization of inadvertent motor deficit during surgery involving the spine or spinal cord.
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Journal of neurosurgery · Oct 2001
Randomized Controlled Trial Clinical TrialAdult respiratory distress syndrome: a complication of induced hypertension after severe head injury.
The factors involved in the development of adult respiratory distress syndrome (ARDS) after severe head injury were studied. The presence of ARDS complicates the treatment of patients with severe head injury, both because hypoxia causes additional injury to the brain and because therapies that are used to protect the lungs and improve oxygenation in patients with ARDS can reduce cerebral blood flow (CBF) and increase intracranial pressure (ICP). In a recent randomized trial of two head-injury management strategies (ICP-targeted and CBF-targeted), a fivefold increase in the incidence of ARDS was observed in the CBF-targeted group. ⋯ Although this clinical trial was not designed to study the association of management strategy and the occurrence of ARDS, the data strongly indicated that induced hypertension in this high-risk group of patients is associated with the development of symptomatic ARDS.
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Prior reports of seizure control following reoperation for failed epilepsy surgery have shown good results. These studies included patients who presented during the era preceding magnetic resonance (MR) imaging, and the patients were often not monitored intracranially or underwent subtotal hippocampal resections. In this study, the authors hypothesized that reoperation for recurrent seizures following a more comprehensive initial workup and surgery would not yield such good results. ⋯ If an aggressive preoperative evaluation and surgical resection are performed, reoperation for recurrent seizures has a much lower likelihood of cure than previously reported. Intentionally palliative surgery such as placement of a VNS unit may be considered for patients in whom the initial operation fails to decrease seizure frequency.