Journal of neurosurgery
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Journal of neurosurgery · Apr 2003
ReviewUsefulness of intraoperative electrical subcortical mapping during surgery for low-grade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 patients.
Although a growing number of authors currently advocate surgery to treat low-grade gliomas, controversy still persists, especially because of the risk of inducing neurological sequelae when the tumor is located within eloquent brain areas. Many researchers performing preoperative neurofunctional imaging and intraoperative electrophysiological methods have recently reported on the usefulness of cortical functional mapping. Despite the frequent involvement of subcortical structures by these gliomas, very few investigators have specifically raised the subject of fiber tracking. The authors in this report describe the importance of mapping cortical and subcortical functional regions by using intraoperative real-time direct electrical stimulations during resection of low-grade gliomas. ⋯ The use of functional mapping of the white matter together with cortical mapping allowed the authors to optimize the benefit/risk ratio of surgery of low-grade glioma invading eloquent regions. Given that preoperative fiber tracking with the aid of neuroimaging is not yet validated, we used intraoperative real-time cortical and subcortical stimulations as a valuable adjunct to the other mapping methods.
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Journal of neurosurgery · Apr 2003
Chronic stimulation of the globus pallidus internus for treatment of non-dYT1 generalized dystonia and choreoathetosis: 2-year follow up.
The authors studied the long-term efficacy of deep brain stimulation (DBS) of the posteroventral lateral globus pallidus internus up to 2 years postoperatively in patients with primary non-DYT1 generalized dystonia or choreoathetosis. The results are briefly compared with those reported for DBS in DYT1 dystonia (Oppenheim dystonia), which is caused by the DYT1 gene. ⋯ Chronic pallidal DBS is a safe and effective procedure in generalized non-DYT1 dystonia, and it may become the procedure of choice in patients with medically refractory dystonia. Postoperative improvement of choreoathetosis is more modest and varied, and subjective ratings of outcome may exceed objective evaluations.
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Journal of neurosurgery · Apr 2003
Case ReportsMultiplication of infantile spinal lipomas after surgical untethering. Report of two cases.
The authors reviewed 63 cases of patients with spinal lipomas who had undergone surgical untethering in childhood and found two infants in whom multiplication of the lipomas occurred within 1 year postoperatively. More importantly, the lipomas dramatically increased in size during infancy. ⋯ Subsequent imaging revealed no change in size of the lesions by 10 and 7 years after reoperation, respectively. This potential for growth of the lipomas should be kept in mind in infants with spinal lipomas who should undergo follow-up neuroimaging.
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Journal of neurosurgery · Apr 2003
Case ReportsBifocal myxopapillary ependymoma of the terminal filum: the end of a spectrum? Case report.
Myxopapillary ependymomas represent the most frequent type of ependymomas found at the conus medullaris-cauda equina-terminal filum level. They are neuroectodermal tumors mainly observed during the fourth decade of life. ⋯ Simultaneous discovery of two tumors located both on the terminal filum has been reported once. The pathogenesis of this focal ependymoma located at the same embryological level, on the terminal filum, is uncertain; it may represent one end of a spectrum, the other end being the giant ependymoma of the terminal filum.
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Journal of neurosurgery · Apr 2003
Case ReportsA new table-fixed retractor for anterior odontoid screw fixation: technical note.
The authors describe a unique retraction device adapted for anterior odontoid screw placement. A rigidly fixed tubular retractor system obviates the need for dissecting the longus colli muscles as well as for excessive retraction of the trachea, esophagus, and recurrent laryngeal nerve. ⋯ The retractor is then rigidly fixed in position. The tubular corridor permits the odontoid screw to be placed in the usual fashion.