Journal of neurosurgery
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Journal of neurosurgery · May 2014
Flow Re-direction Endoluminal Device in treatment of cerebral aneurysms: initial experience with short-term follow-up results.
Flow diverter (FD) stents are relatively new and important devices in the treatment of cerebral aneurysms. The Flow Re-Direction Endoluminal Device has been recently released for clinical use. The authors' aim in this paper is to report their initial single-center FRED experience with short-term results. ⋯ The FRED has an ability to serve neurointerventionalists in the treatment of cerebral aneurysms with its different technical advantages. The occlusion rates with FRED are similar to those with other FD devices. However, these short-term results need to be confirmed with mid- and long-term follow-up results of multicenter large series.
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Journal of neurosurgery · May 2014
Continuous dynamic mapping of the corticospinal tract during surgery of motor eloquent brain tumors: evaluation of a new method.
The authors developed a new mapping technique to overcome the temporal and spatial limitations of classic subcortical mapping of the corticospinal tract (CST). The feasibility and safety of continuous (0.4-2 Hz) and dynamic (at the site of and synchronized with tissue resection) subcortical motor mapping was evaluated. ⋯ Continuous dynamic mapping was found to be a feasible and ergonomic technique for localizing the exact site of the CST and distance to the motor fibers. The acoustic feedback and the ability to stimulate the tissue continuously and exactly at the site of tissue removal improves the accuracy of mapping, especially at low (< 5 mA) stimulation intensities. This new technique may increase the safety of motor eloquent tumor surgery.
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Journal of neurosurgery · May 2014
Case ReportsHigh-resolution ultrasonography and diffusion tensor tractography map normal nerve fascicles in relation to schwannoma tissue prior to resection.
The goals of the present study were to demonstrate the ability of high-resolution ultrasonography to delineate normal nerve fascicles within or around peripheral nerve sheath tumors (NSTs). A blinded examiner evaluated 2 patients with symptomatic upper limb NSTs with high-resolution ultrasonography performed in the perioperative suite using a portable ultrasonography system. Ultrasonographic examinations located the tumor mass and identified the normal nerve fascicles associated with the mass. ⋯ In particular, ultrasonographic examinations accurately identified the surface regions of the tumor without overlying normal nerve tissue. These preliminary data suggest that preoperative ultrasonographic examinations may provide valuable information, supplementary to the information obtained from intraoperative electrophysiological monitoring. Identification of normal nerve tissue prior to surgery may provide additional information regarding the risk of iatrogenic nerve injury during percutaneous tumor biopsy or open resection of the tumor and may also aid in selecting the optimum surgical approach.
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Journal of neurosurgery · May 2014
Comparative StudySuperiority of tympanic ball electrodes over mastoid needle electrodes for intraoperative monitoring of hearing function.
Recording the auditory brainstem response (ABR) is a common method for monitoring the integrity of auditory pathways during surgery in the cerebellopontine angle. Electrocochleography (ECochG) is an alternative means of intraoperative neuromonitoring. In the present study the authors compared the practicability and prognostic significance of these two methods by performing simultaneous recordings in the operating room. ⋯ Intraoperative monitoring of the auditory system by recording with noninvasive tympanic ball electrodes is more practicable than with subcutaneous needle electrodes at the tragus. Since there is also a reliable correlation between ECochG and clinical outcome, the method can replace common ABR recording during surgery in the cerebellopontine angle.
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Journal of neurosurgery · May 2014
Observer reliability of arteriovenous malformations grading scales using current imaging modalities.
The aim of this study was to examine observer reliability of frequently used arteriovenous malformation (AVM) grading scales, including the 5-tier Spetzler-Martin scale, the 3-tier Spetzler-Ponce scale, and the Pollock-Flickinger radiosurgery-based scale, using current imaging modalities in a setting closely resembling routine clinical practice. ⋯ The 5-tier Spetzler-Martin scale, the 3-tier Spetzler-Ponce scale, and the Pollock-Flickinger radiosurgery-based scale all showed a high level of agreement. The improved reliability on reassessment was explained by a training effect from the initial assessment and the requirement to defend the rating, which outlines a potential downside for grades determined as part of routine clinical practice to be used for scientific purposes.