Journal of neurosurgery
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Journal of neurosurgery · Jan 2007
Clinical TrialDecompressive hemicraniectomy in malignant middle cerebral artery infarction: an analysis of long-term outcome and factors in patient selection.
Middle cerebral artery infarction often occurs at a younger age than other strokes and is associated with significant rates of mortality and morbidity. After a period of pessimism regarding decompressive hemicraniectomy in the management of acute stroke, the method has reemerged in the past decade. The present study was undertaken to assess the immediate and long-term outcome of this intervention and to help better define the selection criteria for surgery. ⋯ Survival after decompressive hemicraniectomy was better than previously reported using medical management alone. A vegetative state was avoided and functional independence was possible, especially in younger patients. Increasing age was a statistically significant predictor of disability and long-term functional dependence.
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Journal of neurosurgery · Jan 2007
Recognition and management of delayed hyponatremia following transsphenoidal pituitary surgery.
The goal of this study was to assess the incidence of symptomatic and occult hyponatremia in patients who had undergone transsphenoidal pituitary surgery. ⋯ Delayed hyponatremia occurs more frequently than was previously suspected in patients who have undergone transsphenoidal surgery, especially in female patients and those who have previously had transient DI. The majority of hyponatremic patients remain asymptomatic. Obtaining a serum sodium value on an outpatient basis 1 week after pituitary surgery is helpful in recognition, risk stratification, and subsequent intervention, and may prevent potentially serious complications.
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Journal of neurosurgery · Jan 2007
Case ReportsTransfemoral vein placement of a ventriculoatrial shunt. Technical note.
Acceptable cavities for the distal portion of a cerebrospinal fluid diversion shunt include the peritoneal, pleural, and atrial cavities. The authors report on a patient in whom placement into the peritoneal cavity failed, the pleural cavity was not an option, and access to the right atrium was not technically possible via standard cannulation techniques into the veins of the neck and shoulder regions. ⋯ Eight months postoperatively, the patient's condition was at baseline and there were no signs of shunt malfunction. This technique may prove useful when other measures have failed.
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Journal of neurosurgery · Jan 2007
Case ReportsLemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction. Case report.
Lemierre syndrome is an extremely rare complication of mild-to-moderate pharyngeal infections. The authors present an unusual case of Lemierre syndrome in a 16-year-old boy with cavernous sinus thrombosis and right internal carotid artery narrowing without neurological sequelae, right subdural empyema, and cerebritis in the right temporal and occipital lobes. ⋯ The patient underwent unilateral tonsillectomy, drainage of the peritonsillar abscess, and a myringotomy on the right side. Postoperatively the patient was treated conservatively with antibiotic therapy resulting in an excellent outcome.
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Journal of neurosurgery · Jan 2007
Detection of the subthalamic nucleus in microelectrographic recordings in Parkinson disease using the high-frequency (> 500 hz) neuronal background. Technical note.
Accurate and fast localization of the subthalamic nucleus (STN) during intraoperative electrophysiological monitoring can improve the outcome of deep brain stimulation surgery. The authors show a simple method of detecting the STN that is based on an analysis of the high-frequency (> 500 Hz) background (HFB) activity of neurons. The HFB reflects multiunit spiking activity close to the recording electrode, and its characteristic profile, which is higher in the STN than in neighboring structures, and facilitates delineation of both the dorsal and ventral STN borders.