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
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
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
Case ReportsDelayed aortic rupture caused by an implanted anterior spinal device. Case report.
The authors describe a case of delayed aortic rupture following the application of a smooth-rod Kaneda (SRK) instrument. This is a rare but critical complication of anterior spinal fusion in which instrumentation is placed, and the authors wish to draw attention to the possible complications arising from such surgery. A few cases of this complication were reported in 1986. ⋯ Delayed aortic rupture associated with anterior instrumentation is extremely rare but can occur. Even if the design of the implants can be improved, the placement of implants near the aorta and subsequent changes in the close anatomical relationship between the aorta and the implant eventually may result in this life-threatening complication. Careful follow-up examination and early removal of the implant, if necessary, are important.