Journal of neurosurgery
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Journal of neurosurgery · Mar 2017
A systematic review of outcomes of contralateral C-7 transfer for the treatment of traumatic brachial plexus injury: an international comparison.
OBJECTIVE The effectiveness of contralateral C-7 (CC7) transfer is controversial, yet this procedure has been performed around the world to treat brachial plexus injuries. The authors performed a systematic review to study whether Asian countries reported better outcomes after CC7 transfer compared with "other" countries. METHODS A systematic literature search using PubMed, EMBASE, and 3 Chinese databases was completed. ⋯ For MC nerve outcomes, 75% of patients from both Asia and "other" countries reached M4 and M3 in elbow flexion. CONCLUSIONS Current data did not demonstrate that studies from Asian countries reported better outcomes of CC7 transfer to the median and MC nerves. Future studies should focus on comparing outcomes of different surgical strategies for CC7 transfer.
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Journal of neurosurgery · Mar 2017
Traumatic hemorrhagic brain injury: impact of location and resorption on cognitive outcome.
OBJECTIVE Hemorrhagic contusions are often the most visible lesions following traumatic brain injury. However, the incidence, location, and natural history of traumatic parenchymal hemorrhage and its impact on neurological outcome have been understudied. The authors sought to examine the location and longitudinal evolution of traumatic parenchymal hemorrhage and its association with cognitive outcome. ⋯ CONCLUSIONS Traumatic parenchymal hemorrhages are largely clustered in the frontal and temporal lobes, and significant residual blood products are present at 6 months postinjury, a potential source of ongoing secondary brain injury. Neuropsychological outcome is closely tied to lesion volume size, particularly in the temporal lobe, where larger GRE and FLAIR volumes are associated with more brain atrophy and worse SDMT scores. Interestingly, larger volumes of hemorrhage resorption were associated with worse SDMT and TMT-B scores, suggesting that the initial tissue damage had a lasting impact on attention and executive function.
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Journal of neurosurgery · Mar 2017
Treatment of traumatic brain injury in rats with N-acetyl-seryl-aspartyl-lysyl-proline.
OBJECTIVE The authors' previous studies have suggested that thymosin beta 4 (Tβ4), a major actin-sequestering protein, improves functional recovery after neural injury. N-acetyl-seryl-aspartyl-lysyl-proline (AcSDKP) is an active peptide fragment of Tβ4. Its effect as a treatment of traumatic brain injury (TBI) has not been investigated. ⋯ AcSDKP treatment also significantly inhibited the transforming growth factor-β1/nuclear factor-κB signaling pathway. CONCLUSIONS AcSDKP treatment initiated 1 hour postinjury provides neuroprotection and neurorestoration after TBI, indicating that this small tetrapeptide has promising therapeutic potential for treatment of TBI. Further investigation of the optimal dose and therapeutic window of AcSDKP treatment for TBI and the associated underlying mechanisms is therefore warranted.
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Journal of neurosurgery · Mar 2017
Seizure outcomes after stereotactic radiosurgery for the treatment of cerebral arteriovenous malformations.
OBJECTIVE Patients with cerebral arteriovenous malformations (AVMs) commonly present with seizure. Seizure outcomes in patients treated with stereotactic radiosurgery (SRS) are poorly defined. A case series of patients with cerebral AVMs treated with SRS is presented to evaluate long-term seizure outcome. ⋯ There was no significant correlation between post-SRS seizure status and patient demographic features, comorbidities, AVM characteristics, history of operative intervention, pre- or posttreatment hemorrhage, or radiographic degree of AVM resolution. CONCLUSIONS Stereotactic radiosurgery for treatment of cerebral AVMs is effective at providing long-term control of seizures. A substantial number of patients who were treated with SRS were not only seizure free at their last follow-up, but had been successfully weaned from antiepileptic medications.
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Journal of neurosurgery · Mar 2017
Contralateral supraorbital keyhole approach to medial optic nerve lesions: an anatomoclinical study.
OBJECTIVE The authors describe the supraorbital keyhole approach to the contralateral medial optic nerve and tract, both in a series of cadaveric dissections and in 2 patients. They also discuss the indications and contraindications for this procedure. METHODS In 3 cadaver heads, bilateral supraorbital keyhole minicraniotomies were performed to expose the ipsilateral and contralateral optic nerves. ⋯ RESULTS The supraorbital keyhole craniotomy provided better exposure of the contralateral superomedial nerve than it did of the same portion of the ipsilateral nerve. In both patients gross-total resections of the pathology was achieved. CONCLUSIONS The authors demonstrate the suitability of the contralateral supraorbital keyhole approach for lesions involving the superomedial optic nerve.