Journal of neurosurgery
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Journal of neurosurgery · Mar 2004
Stereotactic radiosurgery for brainstem arteriovenous malformations: factors affecting outcome.
Management options for arteriovenous malformations (AVMs) of the brainstem are limited. The long-term results of stereotactic radiosurgery for these disease entities are poorly understood. In this report the authors reviewed both neurological and radiological outcomes following stereotactic radiosurgery for brainstem AVMs over 15 years of experience. ⋯ Stereotactic radiosurgery provided complete obliteration of AVMs in two thirds of the patients with a low risk of latency-interval hemorrhage. Better three-dimensional imaging studies and conformal dose planning reduced the risk of adverse radiation effects. Younger patients harboring more spherical AVMs that did not involve the tectal plate had the best outcomes.
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Journal of neurosurgery · Mar 2004
Case ReportsAdding or repositioning intracranial electrodes during presurgical assessment of neocortical epilepsy: electrographic seizure pattern and surgical outcome.
The aim of this study was to investigate changes in electroencephalography (EEG) patterns obtained from added or repositioned electrodes after those initially implanted had failed to indicate the true local ictal onset zone. The authors focused on the following matters: rationale for adding or repositioning electrodes, topographic and frequency characteristics of ictal onset before and after adding or repositioning electrodes, the effect of the procedures, and the relationship between changes in intracranial EEG onset patterns and surgical outcomes. ⋯ The addition or reposition of intracranial electrodes with a short-term interval should be considered in selected patients. Spatial restriction of the ictal onset rhythm identified on repeated evaluation is the most important predictor of a good surgical outcome.
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Journal of neurosurgery · Mar 2004
Comparative StudyBiomechanical comparison of anterior and posterior stabilization methods in atlantoaxial instability.
The authors compared the biomechanical stability of two anterior fixation procedures--anterior C1-2 Harms plate/screw (AHPS) fixation and the anterior C1-2 transarticular screw (ATS) fixation; and two posterior fixation procedures--the posterior C-1 lateral mass combined with C-2 pedicle screw/rod (PLM/APSR) fixation and the posterior C1-2 transarticular screw (PTS) fixation after destabilization. ⋯ The PLM/APSR fixation method was found to have the highest biomechanical stiffness followed by PTS, ATS, and AHPS fixation. The PLM/APSR fixation and AATS methods can be considered good procedures for stabilizing the atlantoaxial joints, although specific fixation methods are determined by the proper clinical and radiological characteristics in each patient.
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Journal of neurosurgery · Mar 2004
Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients.
Intraoperative stimulation mapping of subcortical white matter tracts during the resection of gliomas has become a valuable surgical adjunct that is used to reduce morbidity associated with tumor removal. The purpose of this retrospective analysis was to assess the morbidity and functional outcome associated with this method, thus allowing the surgeon to predict the likelihood of causing a temporary or permanent motor deficit. ⋯ In patients with gliomas that are located within or adjacent to the rolandic cortex and, thus, the descending motor tracts, stimulation mapping of subcortical pathways enables the surgeon to identify these descending motor pathways during tumor removal and to achieve an acceptable rate of permanent morbidity in these high-risk functional areas.
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Journal of neurosurgery · Mar 2004
Case ReportsSciatic nerve entrapment in the upper thigh caused by an injury sustained during World War II at the battle of Anzio. Case report.
The authors present an unusual case of sciatic nerve entrapment due to a World War II shrapnel injury to the left thigh suffered during the battle of Anzio in 1943. The patient presented for evaluation of left lower-extremity pain in the sciatic nerve distribution. Magnetic resonance imaging of the lumbosacral spine revealed a disc bulge at L5-S1 that would not explain severe sciatica. ⋯ The patient underwent exploratory external neurolysis of the area, and the sciatic nerve was released from fibrous adhesive entrapment. The patient improved dramatically following surgery. During a 3-year follow-up period, no recurrence of symptoms was noted.