Journal of neurosurgery
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Journal of neurosurgery · Aug 2000
Immediate coma following inertial brain injury dependent on axonal damage in the brainstem.
Immediate and prolonged coma following brain trauma has been shown to result from diffuse axonal injury (DAI). However, the relationship between the distribution of axonal damage and posttraumatic coma has not been examined. In the present study, the authors examine that relationship. ⋯ These results suggest that injury to axons in the brainstem plays a major role in induction of immediate posttraumatic coma and that DAI can occur without coma.
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Journal of neurosurgery · Aug 2000
Continuous monitoring of regional cerebral blood flow: experimental and clinical validation of a novel thermal diffusion microprobe.
Current clinical neuromonitoring techniques lack adequate surveillance of cerebral perfusion. In this article, a novel thermal diffusion (TD) microprobe is evaluated for the continuous and quantitative assessment of intraparenchymal regional cerebral blood flow (rCBF). ⋯ The novel TD microprobe provides a sensitive, continuous, and real-time assessment of intraparenchymal rCBF in absolute flow values that are in good agreement with sXe-rCBF measurements. This study provides the basis for the integration of TD-rCBF into multimodal monitoring of patients who are at risk for secondary brain injury.
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Journal of neurosurgery · Aug 2000
Case ReportsIntentional body clipping of wide-necked basilar artery bifurcation aneurysms.
Neck clipping or coil embolization cannot always achieve complete neck obstruction in wide-necked basilar artery (BA) bifurcation aneurysms. Clipping of the aneurysm body, leaving a small aneurysm rest, is one clipping method used for this kind of aneurysm to maintain the patency of the posterior cerebral arteries and perforating vessels. However, the long-term efficacy of intentional body clipping has not been well investigated. The authors reviewed their experience with intentional body clipping of wide-necked BA bifurcation aneurysms to determine suitable clipping techniques and the long-term efficacy of the procedure. ⋯ Intentional body clipping of wide-necked BA aneurysms proved to be effective to prevent subarachnoid hemorrhage, although injury to perforating arteries remains problematic. The choice of complete neck clipping or body clipping should be established early during the microsurgical procedure to reduce the risk of injury to perforating vessels.
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Journal of neurosurgery · Aug 2000
Sources of error in comparing functional magnetic resonance imaging and invasive electrophysiological recordings.
Several authors have recently reported studies in which they aim to validate functional magnetic resonance (fMR) imaging against the accepted gold standard of invasive electrophysiological monitoring. The authors have conducted a similar study, and in this paper they identify and quantify two characteristics of these data that can make such a comparison problematic. ⋯ These two findings indicate that studies of this sort are currently of limited use for validating fMR imaging and should be interpreted with care. Additional image analysis research is necessary to solve the problems caused by patients' motion and brain deformation.
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Journal of neurosurgery · Jul 2000
Comparative StudyMicroendoscopic posterior cervical foraminotomy: a cadaveric model and clinical application for cervical radiculopathy.
Cervical radiculopathy caused by either soft herniated disc material or foraminal stenosis is a common problem. Anterior and posterior surgical approaches are commonly used to decompress the nerve root. The authors undertook a study to establish the feasibility of performing a microendoscopic posterior approach for cervical foraminotomy in the clinical setting. ⋯ The advantages to this technique include improved intraoperative visualization, a smaller incision, and significantly less postoperative discomfort compared with a traditional keyhole approach.