Journal of neurosurgery
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Journal of neurosurgery · Aug 2013
ReviewThe role of preoperative embolization for intracranial meningiomas.
As endovascular techniques have become more advanced, preoperative embolization has become an increasingly used intervention in the management of meningiomas. To date, however, no consensus has been reached on the use of this technique. To clarify the role of preoperative embolization in the management of meningiomas, the authors conducted a systematic review of case reports, case series, and prospective studies to increase the current understanding of the management options for these common lesions and complications associated with preoperative embolization. ⋯ Preoperative embolization is associated with an added risk for morbidity and mortality. Preoperative embolization may be associated with significant complications, but careful selection of ideal cases for embolization may help reduce any added morbidity with this procedure. Although not analyzed in the authors' study, embolization may still reduce rates of surgical morbidity and mortality and therefore may still have a potential benefit for selected patients. Future prospective studies involving the use of preoperative embolization in certain cases of meningiomas may further elucidate its potential benefit and risks.
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Journal of neurosurgery · Aug 2013
Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording.
In this prospective study the authors' objective was to evaluate the accuracy of deep brain stimulation (DBS) electrode placement using image guidance for direct anatomical targeting with intraoperative CT. ⋯ Placement of DBS electrodes using an intraoperative CT scanner and the NexFrame achieves an accuracy that is at least comparable to other methods.
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Journal of neurosurgery · Aug 2013
Effective treatment of refractory intracranial hypertension after traumatic brain injury with repeated boluses of 14.6% hypertonic saline.
Normal intracranial pressure (ICP) and cerebral perfusion pressure (CPP) have been identified as favorable prognostic factors in the outcome of patients with traumatic brain injuries (TBIs). Osmotic diuretics and hypertonic saline (HTS) are commonly used to treat elevated ICP in patients with TBI; however, sustained effects of repeated high-concentration HTS boluses for severely refractory ICP elevation have not been studied. The authors' goal in this study was to determine whether repeated 14.6% HTS boluses were efficacious in treating severely refractory intracranial hypertension in patients with TBI. ⋯ The subset of TBI patients with intracranial hypertension that is completely refractory to all other medical therapies can be treated effectively and safely with repeated boluses of 14.6% HTS rather than a one-time dose.
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Journal of neurosurgery · Aug 2013
Efficacy of vagus nerve stimulation in brain tumor-associated intractable epilepsy and the importance of tumor stability.
Vagus nerve stimulation (VNS) is a viable option for patients with medically intractable epilepsy. However, there are no studies examining its effect on individuals with brain tumor-associated intractable epilepsy. This study aims to evaluate the efficacy of VNS in patients with brain tumor-associated medically intractable epilepsy. ⋯ Vagus nerve stimulation therapy in individuals with brain tumor-associated medically intractable epilepsy was shown to be comparably effective in regard to seizure reduction and response rates to the general population of VNS therapy patients. Outcomes were better in patients with stable as opposed to progressing tumors. The authors' findings support the recommendation of VNS therapy in patients with brain tumor-associated intractable epilepsy, especially in cases in which imminent tumor progression is not expected. Vagus nerve stimulation may not be indicated in more malignant tumors.
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Journal of neurosurgery · Aug 2013
Diminished default mode network recruitment of the hippocampus and parahippocampus in temporal lobe epilepsy.
Functional neuroimaging has shown that the brain organizes into several independent networks of spontaneously coactivated regions during wakeful rest (resting state). Previous research has suggested that 1 such network, the default mode network (DMN), shows diminished recruitment of the hippocampus with temporal lobe epilepsy (TLE). This work seeks to elucidate how hippocampal recruitment into the DMN varies by hemisphere of epileptogenic focus. ⋯ This study demonstrated that recoding brain regions by the laterality to their epileptogenic focus increases the power of statistical approaches for finding interhemispheric differences in brain function. Using this approach, the authors showed TLE to selectively diminish connectivity of the hippocampus and parahippocampus in the hemisphere of the epileptogenic focus. This approach may prove to be a useful method for determining the seizure onset zone with TLE, and could be broadly applied to other neurological disorders with a lateralized onset.