Journal of neurosurgery
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Journal of neurosurgery · Mar 2015
Case Reports Comparative StudyA prospective comparative study of microscope-integrated intraoperative fluorescein and indocyanine videoangiography for clip ligation of complex cerebral aneurysms.
The authors prospectively analyzed 2 microscope-integrated videoangiography techniques using intravenous indocyanine green (ICG) and fluorescein for assessment of cerebral aneurysm obliteration and adjacent vessel patency. ⋯ Compared with ICG-VA, FL-VA can potentially provide an improved visualization of vasculature at high magnification in deep surgical fields. ICG-VA is more effective for repeated use during clip repositioning due to ICG's minimal vascular wall extravasation. Therefore, in certain cases, FL-VA may offer some advantages and play a complementary role along with ICG-VA in intraoperative fluorescence evaluation during microsurgical management of aneurysms.
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Journal of neurosurgery · Mar 2015
Vertebral artery transposition for revascularization of the posterior circulation: a critical assessment of temporary and permanent complications and outcomes.
Despite advances in medical management and endovascular therapies, including the introduction of statins, antiplatelet agents, and drug-eluting stents, some patients experience medically refractory vertebrobasilar insufficiency and may benefit from robust surgical revascularization. The aim of this study was to evaluate such patients after surgical revascularization, emphasizing long-term outcomes and rates of complications. ⋯ Despite the optimization of medical therapies and lifestyle modifications, a select subset of patients with posterior vascular circulation insufficiency remains. In the authors' experience, vertebral artery-carotid artery transposition provides a surgical option with relatively low long-term complication and restenosis rates that are comparable or lower than those reported with endovascular treatment.
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Journal of neurosurgery · Mar 2015
Racial and ethnic disparities in discharge to rehabilitation following traumatic brain injury.
Disparities in access to inpatient rehabilitation services after traumatic brain injury (TBI) have been identified, but less well described is the likelihood of discharge to a higher level of rehabilitation for Hispanic or black patients compared with non-Hispanic white patients. The authors investigate racial disparities in discharge destination (inpatient rehabilitation vs skilled nursing facility vs home health vs home) following TBI by using a nationwide database and methods to address racial differences in prehospital characteristics. ⋯ Adult Hispanic and black patients with TBI are significantly less likely to receive intensive rehabilitation than their non-Hispanic white counterparts; notably, this difference persists in the Medicare population (age ≥ 65 years), indicating that uniform insurance coverage alone does not account for the disparity. Given that insurance coverage and a wide range of prehospital characteristics do not eliminate racial disparities in discharge destination, it is crucial that additional unmeasured patient, physician, and institutional factors be explored to eliminate them.
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Journal of neurosurgery · Mar 2015
Case ReportsDetection of third and sixth cranial nerve palsies with a novel method for eye tracking while watching a short film clip.
Automated eye movement tracking may provide clues to nervous system function at many levels. Spatial calibration of the eye tracking device requires the subject to have relatively intact ocular motility that implies function of cranial nerves (CNs) III (oculomotor), IV (trochlear), and VI (abducent) and their associated nuclei, along with the multiple regions of the brain imparting cognition and volition. The authors have developed a technique for eye tracking that uses temporal rather than spatial calibration, enabling detection of impaired ability to move the pupil relative to normal (neurologically healthy) control volunteers. This work was performed to demonstrate that this technique may detect CN palsies related to brain compression and to provide insight into how the technique may be of value for evaluating neuropathological conditions associated with CN palsy, such as hydrocephalus or acute mass effect. ⋯ This proof of concept series of cases suggests that the use of eye tracking to detect CN palsy while the patient watches television or its equivalent represents a new capacity for this technology. It may provide a new tool for the assessment of multiple CNS functions that can potentially be useful in the assessment of awake patients with elevated intracranial pressure from hydrocephalus or trauma.
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Journal of neurosurgery · Mar 2015
Intraoperative computed tomography for intracranial electrode implantation surgery in medically refractory epilepsy.
Accurate placement of intracranial depth and subdural electrodes is important in evaluating patients with medically refractory epilepsy for possible resection. Confirming electrode locations on postoperative CT scans does not allow for immediate replacement of malpositioned electrodes, and thus revision surgery is required in select cases. Intraoperative CT (iCT) using the Medtronic O-arm device has been performed to detect electrode locations in deep brain stimulation surgery, but its application in epilepsy surgery has not been explored. In the present study, the authors describe their institutional experience in using the O-arm to facilitate accurate placement of intracranial electrodes for epilepsy monitoring. ⋯ The O-arm device can be easily incorporated into routine intracranial electrode implantation surgery in standard-sized operating rooms. The technique provides accurate 3D visualization of depth and subdural electrode contacts, and the intraoperative images can be easily merged with preoperative MRI studies to confirm lead positions before final wound closure. Intraoperative CT obviates the need for routine postoperative CT and has the potential to improve the accuracy of intracranial electroencephalography recordings and may reduce the necessity for revision surgery.