Journal of neurosurgery
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Journal of neurosurgery · Mar 2004
Monitoring of motor evoked potentials compared with somatosensory evoked potentials and microvascular Doppler ultrasonography in cerebral aneurysm surgery.
The aims of this study were to compare the efficiency of motor evoked potentials (MEPs), somatosensory evoked potentials (SSEPs), and microvascular Doppler ultrasonography (MDU) in the detection of impending motor impairment from subcortical ischemia in aneurysm surgery; to determine their sensitivity for specific intraoperative events; and to compare their impact on the surgical strategy used. ⋯ Monitoring of MEPs is superior to SSEP monitoring and MDU in detecting motor impairment, particularly that from subcortical ischemia. Microvascular Doppler ultrasonography is superior to EP monitoring in detecting inadvertent vessel occlusion, but cannot assess remote collateral flow. Motor evoked potentials are most sensitive to all other intraoperative conditions and have a direct influence on the course of surgery in the majority of events. A controlled study design is required to confirm the positive effect of monitoring on clinical outcome in aneurysm surgery.
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Journal of neurosurgery · Mar 2004
Case ReportsPseudoaneurysm of the thoracic radiculomedullary artery with subarachnoid hemorrhage. Case report.
The authors report a rare case of a patient with a left-sided T-5 radiculomedullary artery pseudoaneurysm who presented with spinal subarachnoid hemorrhage (SAH). The patient, a 71-year-old woman, was hospitalized for progressive paraplegia and sensory loss with bladder and rectal dysfunction. ⋯ Spinal angiography revealed a tiny masslike staining without arteriovenous shunting. The resected specimen, which caused the spinal SAH, was diagnosed as a pseudoaneurysm based on operative and pathological findings.
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Journal of neurosurgery · Mar 2004
Case ReportsMagnetic and electrical stimulation of the auditory cortex for intractable tinnitus. Case report.
Tinnitus is a distressing symptom that affects up to 15% of the population for whom no satisfactory treatment exists. The authors present a novel surgical approach for the treatment of intractable tinnitus, based on cortical stimulation of the auditory cortex. Tinnitus can be considered an auditory phantom phenomenon similar to deafferentation pain, which is observed in the somatosensory system. ⋯ Postoperatively, the patient's tinnitus disappeared and remains absent 10 months later. Focal extradural electrical stimulation of the primary auditory cortex at the area of cortical plasticity is capable of suppressing contralateral tinnitus completely. Transcranial magnetic stimulation may be an ideal method for noninvasive studies of surgical candidates in whom stimulating electrodes might be implanted for tinnitus suppression.
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Journal of neurosurgery · Mar 2004
Case ReportsCervical peridural calcification in patients undergoing long-term hemodialysis. Report of two cases.
The authors report on two patients undergoing long-term hemodialysis in whom cervical myelopathy was caused by calcification related to the cervical dural sac. The lesions were demonstrated on plain computerized tomography (CT) scans as dotted curvilinear bands outlining the dural sacs in almost the whole of their cervical spines. ⋯ In each case, the spinal cord could not be decompressed by merely enlarging the osseous spinal canal; rather, it required removal of the calcified membrane from the posterior surface of the dura. Based on the operative findings, the lesion should be described as cervical peridural calcification.
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Journal of neurosurgery · Mar 2004
Retrospective study of surgery-related outcomes in patients with syringomyelia associated with Chiari I malformation: clinical significance of changes in the size and localization of syrinx on pain relief.
Pain is one of the major symptoms in patients with syringomyelia; however, its origin is not fully understood, and postoperative improvement of pain is difficult to predict. The objectives of this study were to assess the surgery-related results obtained in patients who underwent treatment for syringomyelia associated with Chiari I malformation, particularly related to pain status, and to identify factors that may influence improvement in postoperative pain by comparing pre- and postoperative magnetic resonance (MR) imaging findings. ⋯ Neurons in the dorsal horn were thought to be involved in the development of pain as a result of the deafferentiation mechanism in cases of syringomyelia.