Neurosurgery
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This article traces some of the developments in the practice of neurosurgery which have come about dependent upon certain technological advances.
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Review
Intraoperative nerve action potential recordings: technical considerations, problems, and pitfalls.
The purpose of this article is to provide our experience with intraoperative nerve action potential (NAP) recordings. In particular, we focus on a discussion of the technical considerations of intraoperative NAP with emphasis on identifying and remedying problems and pitfalls. ⋯ Visual inspection of a nerve lesion in continuity can be misleading. Although there is no "head-to-head" comparison of our data with data obtained without the use of intraoperative NAP recordings, we feel strongly that with experience and knowledge of the problems and pitfalls regarding intraoperative recording techniques, one may take advantage of the great benefits of this very useful and informative surgical tool.
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We developed an augmented reality system that enables intraoperative image guidance by using 3-dimensional (3D) graphics overlaid on a video stream. We call this system DEX-Ray and report on its development and the initial intraoperative experience in 12 cases. ⋯ The system was perceived as an improved navigational experience because the augmented see-through effect allowed direct understanding of the surgical anatomy beyond the visible surface and direct guidance toward surgical targets.
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Traumatic brain injury (TBI) causes an increase in matrix metalloproteinases (MMPs), which are associated with neuroinflammation, blood-brain barrier disruption, hemorrhage, and cell death. We hypothesized that patients with TBI have an increase in MMPs in ventricular cerebrospinal fluid (CSF) and plasma. ⋯ We show that MMPs are increased in the CSF of TBI patients. Although the number of patients was small, the results were robust and clearly demonstrated increases in MMP-3 and MMP-9 in ventricular CSF in TBI patients compared with controls. Although these preliminary results will need to be replicated, we propose that MMPs may be important in blood-brain barrier opening and hemorrhage secondary to brain injury in patients.
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To review the clinical outcomes in our patients who have undergone nerve transfer operations for brachial plexus reconstruction at the Louisiana State University (LSU) over a 10-year period. A secondary objective is to compare clinical outcomes in patients who had only nerve transfer operations as compared with patients whose nerve transfers were supplemented with direct repair of brachial plexus elements. ⋯ Nerve transfers for repair of brachial plexus injuries result in excellent recovery of elbow and shoulder functions. Patients who had direct repair of brachial plexus elements in addition to nerve transfers tended to do better than those who had only nerve transfer operations.