Journal of neurosurgery
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Journal of neurosurgery · Oct 2009
Relationships between essential cortical language sites and subcortical pathways.
Maps produced using either electrical stimulation or functional imaging have demonstrated a distributed network of cortical regions involved in expressive and receptive language tasks. The pattern of connectivity among components of this network has begun to be explored with diffusion tensor (DT) imaging, but has yet to be completely characterized. In this study the authors used DT imaging-based tractography to examine the interrelationship between cortical areas found to be essential for language by intraoperative electrical stimulation. ⋯ The deficits evoked by subcortical stimulation validate and demonstrate the utility of this AF localization technique, and provide further evidence that the AF is an important pathway for fluent language. Taken together, these results demonstrate that DT imaging of the AF may be used to predict the location of brain areas that will be eloquent by the standards of stimulation mapping.
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Journal of neurosurgery · Oct 2009
Management guided by brain tissue oxygen monitoring and outcome following severe traumatic brain injury.
The authors sought to describe changes in clinical management associated with brain tissue oxygen (PbO(2)) monitoring and how these changes affected outcomes and resource utilization. ⋯ The mortality rate in patients with traumatic brain injury whose clinical management was guided by PbO(2) monitoring was not reduced in comparison with that in patients who received ICP monitoring alone. Brain tissue oxygen monitoring was associated with worse neurological outcome and increased hospital resource utilization.
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Journal of neurosurgery · Oct 2009
Prediction of intracranial computed tomography findings in patients with minor head injury by using logistic regression.
The aim of this study was to develop a decision rule for physicians in developing countries to identify patients with minor head injury who will benefit from emergency brain CT scanning. ⋯ The decision rule developed by the authors appears to be 100% sensitive and 46% specific for positive findings on brain CT and will, in developing countries, help clarify the decision to obtain scans.
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Journal of neurosurgery · Oct 2009
Sensitivity of high-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled-gradient recalled imaging in the prediction of neurovascular compression in patients with hemifacial spasm.
Hemifacial spasm is a clinical syndrome caused by vascular compression of the facial nerve in the cerebellopontine angle, which can be relieved by surgical intervention. Advances in medical imaging technology allow for direct visualization of the offending blood vessels in hemifacial spasm and similar conditions (such as trigeminal neuralgia). The utility of high resolution 3D MR angiography and 3D spoiled-gradient recalled (SPGR) imaging sequences for surgical decision-making in hemifacial spasm, as measured by sensitivity, specificity, and positive and negative predictive values, has not been previously determined. ⋯ Although high-resolution 3D MR angiography and 3D SPGR imaging was helpful in providing information about the anatomical relationship of cranial nerve VII and surrounding blood vessels, the authors determined that in the case of hemifacial spasm these types of imaging did not influence preoperative surgical decisionmaking.