Neurosurgery
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Clinical Trial
Use of ultrasonic aspiration for dural opening in cranial reoperations: technical note.
Dural detachment from the brain in cranial reoperations has been accomplished previously by selective coagulation and the cutting of brain-dural adhesions. The results of ultrasonic aspiration during tumor surgery or brain cutting procedures led the authors to speculate that the detachment of the dura mater from brain tumors by applying the Cavitron ultrasonic surgical aspirator (Valleylab, Boulder, CO [formerly Cavitron, Inc., Stamford, CT]) to the brain-dura mater interface could be used to reduce bleeding and facilitate dural opening during cranial reoperations. ⋯ Incremental dural opening and brain visualization is achieved by careful application of ultrasonic aspiration directly into the brain-dura limit, producing immediate regional dural devascularization. Use of this technique reduces cortical and dural bleeding and enhances the ease and effectiveness of brain visualization.
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Jugular foramen tumors are rare cranial base lesions that present diagnostic and management difficulties. With the availability of new diagnostic procedures these tumors have been more precisely studied and questions of whether, when, and how these lesions should be treated often arise. Data from 106 consecutive patients surgically treated in the past 17 years were retrospectively analyzed to identify surgical outcomes. ⋯ Radical removal of benign jugular foramen tumors is the treatment of choice and may be curative. Large lesions can be radically excised in one surgical procedure with preservation of lower cranial nerves. Cranial base reconstruction with vascularized myofascial flaps reduces the incidence of postoperative cerebrospinal fluid leakage. Damage of the lower cranial nerves is the most serious surgical complication.
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Clinical Trial
Volumetric image guidance for motor cortex stimulation: integration of three-dimensional cortical anatomy and functional imaging.
Epidural electrical stimulation of the motor cortex is a promising treatment option in patients with intractable pain. Varying rates of success in long-term pain relief have been attributed to inaccurate positioning of the electrode array, partly because the sulcal landmarks are not directly visualized. We describe an integrated protocol for precise electrode placement, combining functional image guidance and intraoperative electrical stimulation in the awake patient. ⋯ The combination of 3-D functional neuronavigation, intraoperative electrical stimulation, and continuous motor output monitoring in awake patients provides optimal information for the identification of the appropriate somatotopic area of motor cortex. This combined imaging and stimulation approach for electrode positioning offers a safe and minimal invasive strategy for the treatment of intractable chronic pain in selected patients.
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Case Reports
Aggressive cranial vault decompression for cranial hyperostosis: technical case report of two cases.
Camurati-Engelmann's disease, also known as progressive diaphysial dysplasia, is a disorder of the bone metabolism. Neurological manifestations of progressive diaphysial dysplasia include cranial nerve dysfunction, generalized weakness, cerebellar herniation, and increased intracranial pressure. In the past, surgical intervention has been of limited and temporary benefit. We present two patients with cranial hyperostosis secondary to Camurati-Engelmann's disease who were treated successfully with a single surgery involving a combination of multiple craniotomies for cranial vault decompression. ⋯ Effective surgical options are needed for clinically significant cranial hyperostosis. In an effort to further define operative management in these patients, we describe a single, aggressive surgical procedure that may be used for successful cranial decompression.
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Clinical Trial
Localized transcranial electrical motor evoked potentials for monitoring cranial nerves in cranial base surgery.
To describe a novel monitoring technique that allows "functional" assessment of cranial nerve continuity during cranial base surgery. ⋯ Facial nerve MEPs recorded intraoperatively during cranial base surgery using the proposed technique predicts immediate postoperative facial nerve outcome. This technique can also be used to monitor other motor cranial nerves in cranial base surgery.