Neurosurgery
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Intraoperative magnetic resonance imaging (MRI) is now available with the General Electric MRI system for dedicated intraoperative use. Alternatively, non-dedicated MRI systems require fewer specific adaptations of instrumentation and surgical techniques. In this report, clinical experiences with such a system are presented. ⋯ Intraoperative MRI with the Magnetom Open provides considerable additional information to optimize resection during surgical treatment of supratentorial tumors, pituitary adenomas, and epilepsy. The twin operating theater is a true alternative to a dedicated MRI system. Additional efforts are necessary to improve patient transportation time and instrument guidance within the scanner.
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Traumatic intraventricular hemorrhage (IVH) can result in association with acute obstructive hydrocephalus, repetitive malfunction of external ventricular drains (EVDs), and uncontrollable increased intracranial pressure. We report a case showing the safe and effective use of intraventricular recombinant-tissue plasminogen activator in a child with severe brain injury and acute hydrocephalus from IVH. ⋯ With obstructive hydrocephalus secondary to acute traumatic IVH that cannot be controlled with EVD because of recurrent obstruction from intraventricular blood, intraventricular recombinant-tissue plasminogen activator can be effective and safe, despite preexisting multiple hemorrhagic intracranial injuries.
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Endothelin (ET) immunoreactivity, ET production, and specific ET receptors have been identified in the brain. Changes in ET concentration or receptor expression have been implicated in the pathophysiological changes in vasospasm after subarachnoid hemorrhage and in cerebral neoplasia. In this study, we have characterized the ET(A) and ET(B) receptor subtypes present in human normal cerebral cortex (NCC) and two common central nervous system tumors, i.e., meningioma (MNG) and glioblastoma multiforme (GBM). A knowledge of the ET receptor subtypes present may provide a novel therapeutic target for newly developed ET antagonists. ⋯ ET(A) receptors are expressed in high concentrations in MNGs and in the vasculature of NCC and GBMs. The ET(A)-selective antagonist PD156707 may be of potential therapeutic value in vascular and neoplastic diseases of the central nervous system.
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Extraforaminal disc herniations today are operated on via the so-called lateral approach. Clinical experience has shown that in contrast to levels L2/3-L4/5, this approach may become extremely difficult at the L5-S1 level. According to new microanatomic studies, the previous lateral approaches at this level often do not allow access to the neuroforamen without partial or total destruction of the L5-S1 facet joint. Postoperatively, this may lead to joint irritation with consecutive low back and pseudoradicular pain. To preserve the facet joint, a new approach was developed based on an anatomic study. ⋯ Using this new approach, the L5-S1 joint remains intact. Space for instrumental manipulations is created in areas not essential for joint function. For this procedure, newly defined anatomic landmarks, such as the ileolumbar ligament, upper edge of the sacrum, lateral rim of the apophyseal joint, and para-articular notch, guide the operative route. In accordance with the preliminary anatomic studies, this approach was successfully used in 13 patients, and we think that it is a promising alternative that helps to preserve joint function and dorsal root ganglion integrity.