Journal of neurosurgery
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Journal of neurosurgery · Aug 2003
Preoperative correlation of intraoperative cortical mapping with magnetic resonance imaging landmarks to predict localization of the Broca area.
Broca identified the posterior third of the inferior frontal gyrus as a locus essential for the production of fluent speech. The authors have conducted this retrospective analysis in an attempt to find readily identifiable landmarks on magnetic resonance (MR) imaging that correspond to intraoperative cortical stimulation-induced speech arrest. These landmarks demonstrate novel structural-functional relationships that can be used preoperatively to predict the location of the Broca area. ⋯ The results indicate a correlation between the structure of the frontal operculum as seen on MR imaging and the functional localization of speech arrest in the dominant hemisphere. Additionally, sulcal landmarks that can be used preoperatively to predict the location of the Broca area within the inferior frontal gyrus are described based on the patient population. This information will allow the surgeon to determine if an awake craniotomy is necessary to identify the Broca area when planning a surgical procedure near the dominant frontal operculum.
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Journal of neurosurgery · Aug 2003
Multicenter Study Clinical TrialPeroneal intraneural ganglia: the importance of the articular branch. Clinical series.
The peroneal nerve is the most common site of intraneural ganglia. The neurological deficit associated with these cysts is often severe and the operation to eradicate them is difficult The aims of this multicenter study were to collate the authors' experience with a relatively rare lesion and to improve clinical outcomes by better understanding its controversial pathogenesis. ⋯ The clinical presentation, electrical studies, imaging characteristics, and operative observations regarding peroneal intraneural ganglia are predictable. Treatment must address the underlying pathoanatomy and should include decompression of the cyst and ligation of the articular branch of the nerve. To avoid extraneural recurrence, resection of the superior tibiofibular joint may also be necessary, but indications for this additional procedure need to be defined. These recommendations are based on the authors' belief that intraneural peroneal ganglia arise from the superior tibiofibular joint and are connected to it by the articular branch.
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Journal of neurosurgery · Aug 2003
Randomized Controlled Trial Clinical TrialEfficacy of aprotinin in children undergoing craniofacial surgery.
This prospective, randomized, placebo-controlled, double-blind trial was undertaken to assess the efficacy of aprotinin in reducing the need for blood transfusions in 39 children undergoing reconstructive craniofacial surgery. ⋯ Aprotinin decreased blood transfusion requirements in pediatric patients undergoing craniofacial reconstruction, thereby reducing the risks associated with exposure to banked blood components.
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The sphenopetroclival area is the border zone between the middle and posterior cranial fossa. Several authors have studied the microsurgical anatomy of this region and have furnished sometimes contradictory descriptions of this area, which still represents a great challenge for the neurosurgeon. On the basis of previous anatomical data reported in the literature, the authors undertook a new microanatomical analysis of the sphenopetroclival region and report their findings. ⋯ The structures defining the posterior surface of the SPCVG may represent a helpful surgical corridor through which it is possible to approach the LSC via the posterior fossa. This conceptualization of the SPCVG is an attempt to define univocally the microanatomy of the sphenopetroclival region in its entirety.
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Journal of neurosurgery · Aug 2003
Upregulation of neurogenesis and reduction in functional deficits following administration of DEtA/NONOate, a nitric oxide donor, after traumatic brain injury in rats.
Neurogenesis, which is upregulated by neural injury in the adult mammalian brain, may be involved in the repair of the injured brain and functional recovery. Therefore, the authors sought to identify agents that can enhance neurogenesis after brain injury, and they report that (Z)-1-[N-(2-aminoethyl)-N-(2-ammonioethyl)amino]diazen-1-ium-1,2-diolate (DETA/NONOate), a nitric oxide donor, upregulates neurogenesis and reduces functional deficits after traumatic brain injury (TBI) in rats. ⋯ Compared with control rats, the proliferation, survival, migration and differentiation of neural progenitor cells were all significantly enhanced in the hippocampus, subventricular zone, striatum, corpus callosum, and the boundary zone of the injured cortex, as well as in the contralateral hemisphere in rats with TBI that received DETA/ NONOate treatment. Neurological functional outcomes in the DETA/NONOate-treated group were also significantly improved compared with the untreated group. These data indicate that DETA/NONOate may be useful in the treatment of TBI.