Neurosurgery
-
Despite intraoperative technical improvements, the insula remains a challenging area for surgery because of its critical relationships with vascular and neurophysiological functional structures. ⋯ With intraoperative cortico-subcortical mapping and neurophysiological monitoring, a major resection is possible with an acceptable risk and a significant result in the follow-up.
-
Emissary veins connect the extracranial venous system with the intracranial venous sinuses. These include, but are not limited to, the posterior condyloid, mastoid, occipital, and parietal emissary veins. ⋯ Detailed descriptions of these venous structures are lacking in the literature, and, to the authors', knowledge, this is the first detailed review to discuss the anatomy, pathology, anomalies, and clinical effects of the cranial emissary veins. Our hope is that such data will be useful to the neurosurgeon during surgery in the vicinity of the emissary veins.
-
The suppression of the growth hormone (GH) on an oral glucose tolerance test (OGTT) has been accepted as the most reliable parameter for determining remission of acromegaly. ⋯ Immediate postoperative GH level is a very good predictor of long-term outcome in acromegaly. One-week postoperative OGTT is also a good predictor with high specificity. These findings may provide critical information for the determination of adjuvant treatment after surgery.
-
Mannitol has traditionally been the mainstay of medical therapy for intracranial hypertension in patients with head injury. We previously demonstrated that mannitol reduces brain volume in patients with cerebral edema, although whether this occurs because of a reduction in brain water, blood volume, or both remains poorly understood. ⋯ A single bolus of 1 g/kg of 20% mannitol does not acutely lower CBV. Another mechanism, such as a reduction in brain water, may better explain mannitol's ability to lower intracranial pressure and reduce mass effect.
-
There is no consensus regarding optimal position of an external ventricular drain (EVD) with regard to clearance of intraventricular hemorrhage (IVH). ⋯ It is possible that placement of EVD may be optimized to enhance the clearance of total IVH if lytic agents are used. Catheters on either side can clear the third and fourth ventricles with equal efficiency.