Journal of neurosurgery
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Journal of neurosurgery · Nov 2007
Cortical and subcortical brain shift during stereotactic procedures.
The success of stereotactic surgery depends upon accuracy. Tissue deformation, or brain shift, can result in clinically significant errors. The authors measured cortical and subcortical brain shift during stereotactic surgery and assessed several variables that may affect it. ⋯ Cortical and subcortical brain shift occurs during stereotactic surgery as a direct function of the volume of pneumocephalus, which probably reflects the volume of CSF that is lost. Clinically significant shifts appear to be uncommon, but stereotactic surgeons should be vigilant in preventing CSF loss.
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Journal of neurosurgery · Nov 2007
Brain shift: an error factor during implantation of deep brain stimulation electrodes.
The goal of this study was to focus on the tendency of brain shift during stereotactic neurosurgery and the shift's impact on the unilateral and bilateral implantation of electrodes for deep brain stimulation (DBS). ⋯ To note the tendency of the brain to shift is very important for accurate implantation of a DBS electrode or high frequency thermocoagulation, as well as for the prediction of therapeutic and adverse effects of stereotactic surgery.
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Journal of neurosurgery · Nov 2007
Incidence of symptomatic hemorrhage after stereotactic electrode placement.
Intracranial hemorrhage (ICH) is the most significant complication associated with the placement of stereotactic intracerebral electrodes. Previous reports have suggested that hypertension and the use of microelectrode recording (MER) are risk factors for cerebral hemorrhage. The authors evaluated the incidence of symptomatic ICH in a large cohort of patients with various diseases treated with stereotactic electrode placement. They examined the effect of comorbidities on the risk of ICH and independently assessed the risks associated with age, sex, use of MER, diagnosis, target location, hypertension, and previous use of anticoagulant medications. The authors also evaluated the effect of hemorrhage on length of hospital stay and discharge disposition. ⋯ The placement of stereotactic electrodes is generally safe, with a symptomatic hemorrhage rate of 1.2%, and a 0.7% rate of permanent neurological deficit. Consistent with prior reports, this study confirms that hypertension is a significant risk factor for hemorrhage. Age, male sex, and diagnosis of PD were also significant risk factors. Patients with symptomatic hemorrhage had longer hospital stays and were less likely to be discharged home.
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Journal of neurosurgery · Nov 2007
Significance of the tentorial alignment in approaching the trigeminal nerve and the ventral petrous region through the suboccipital retrosigmoid technique.
In this study, the authors aimed to identify the factors that would predict the operative distance between the trigeminal nerve (fifth cranial nerve) and the acousticofacial nerve complex (seventh-eighth cranial nerves) preoperatively when approaching the cerebellopontine angle (CPA) through the suboccipital retrosigmoid approach. ⋯ The distance between the trigeminal nerve and acousticofacial nerve complex decreases in the presence of a steep tentorial angle. This limits the operating field between these cranial nerves when reaching the petroclival or the superior CPA regions through the retrosigmoid approach. Awareness of such anatomical features at the time of preoperative planning is of paramount importance in selecting the optimum surgical approach and minimizing operative complications.