Neurosurgery
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Awake brain tumor surgery is a unique opportunity for mapping sensorimotor and cognitive functions, allowing the operator to optimize the resection while preserving the patient's quality of life. During this type of procedure, active participation of the patient is necessary. ⋯ Intermittent general anesthesia with controlled ventilation for this type of neurosurgical procedure remains an anesthesiological challenge. However, the results of this study suggest that it may be feasible, reproducible, and relatively safe in the context of a standardized protocol involving members of both anesthesiology and surgery teams. Such a technique has a great potential to improve the surgical results, from both oncological and functional perspectives.
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It has been postulated that the Gosling pulsatility index (PI) assessed with transcranial Doppler (TCD) has a diagnostic value for noninvasive estimation of intracranial pressure (ICP) and cerebral perfusion pressure (CPP). ⋯ Overall, the value of TCD-PI to assess ICP and CPP noninvasively is very limited. However, extreme values of PI can still potentially be used in support of a decision for invasive ICP monitoring.
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Maintaining flow in a newly established high-flow bypass into the intracranial circulation may be threatened by low blood pressure. ⋯ Early postoperative mean arterial pressure less than approximately 60 mm Hg may induce blood flow in the bypass to decrease to less than 40 mL/min, a flow below which low shear stress may lead to early graft occlusion.
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The primary motor cortex, which is part of the corticobasal ganglia loops, may be an alternative option for the surgical treatment of Parkinson disease. ⋯ Extradural motor cortex stimulation is a safe procedure. After 12 months, the patients demonstrated a moderate improvement of motor symptoms (particularly axial symptoms) and quality of life.
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The long-term outcome of superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is unclear. We report a very rare case of a de novo aneurysm after bypass surgery. ⋯ This is the first reported case of a de novo MCA aneurysm that developed at a site remote from STA-MCA anastomosis because of hemodynamic force. Therefore, long-term control of blood pressure and repeated imaging examination should be performed to confirm patency and to identify aneurysm formation after STA-MCA bypass.