Journal of neurosurgery
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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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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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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.
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Journal of neurosurgery · Oct 2001
Review Case ReportsCerebellar liponeurocytoma. Case report and review of the literature.
Cerebellar liponeurocytoma is a rare tumor of the posterior fossa that has many morphological similarities to medulloblastoma and neurocytoma. Recently the World Health Organization working group for classification of central nervous system neoplasms adopted the term "cerebellar liponeurocytoma" to provide a unified nomenclature for a tumor variously labeled in the literature as lipomatous medulloblastoma, lipidized medulloblastoma, medullocytoma. neurolipocytoma, lipomatous glioneurocytoma, and lipidized mature neuroectodermal tumor of the cerebellum. The rarity of this tumor and paucity of pertinent information regarding its biological potential and natural history have resulted in the application of various treatment modalities. It is suggested in the available literature that these lesions have a much more favorable prognosis than typical medulloblastomas, and that adjuvant therapy for liponeurocytoma need not be as extensive as that administered for medulloblastomas.
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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.