Neurosurgery
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Clinical Trial
The hybrid operculo-insular electrode: a new electrode for intracranial investigation of perisylvian/insular refractory epilepsy.
Precise localization of an epileptic focus in the perisylvian/insular area is a major challenge. The difficult access and the high density of blood vessels within the sylvian fissure have lead to poor coverage of intrasylvian (opercular and insular) cortex by available electrodes. ⋯ The new hybrid operculo-insular electrode can be used for intracranial investigation of perisylvian/insular refractory epilepsy. It can contribute to increasing cortical coverage of this complex region and may allow better definition of the epileptic focus.
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The mechanisms and management of delayed intracerebral hemorrhage (dICH) after treatment of brain arteriovenous malformations (AVMs) are poorly understood and widely debated. Many clinical predictive factors have been theorized for dICH after an otherwise uneventful AVM embolization, but there is an absence of data to discern their significance. ⋯ High volume of embolic agent administered per procedure is an independent predictive factor for dICH. Limiting the injected volume for each procedure may reduce this poorly understood complication.
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In injuries of the lower brachial plexus, finger flexion can be restored by nerve or tendon transfer. However, there is no technique that can guarantee good recovery of finger and thumb extension. ⋯ The supinator muscle branch is likely the best donor nerve for the repair of lower brachial plexus injuries affecting muscles that are innervated by the posterior interosseous nerve.
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Monitoring brain tissue PO2 (PbtO2) is part of multimodality monitoring of patients with traumatic brain injury (TBI). However, PbtO2 measurement is a sampling of only a small area of tissue surrounding the sensor tip. ⋯ These results suggest that the location of the PbtO2 probe determines the PbtO2 values and the relationship of PbtO2 to neurological outcome.
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The use of intravenous recombinant tissue plasminogen activator (IV rtPA) has become an integral part of modern acute ischemic stroke management; however, its use has been associated with the development of intracranial hemorrhage in 6.4% of patients. It is possible that underlying and unsuspected vascular lesions, such as cerebral aneurysms, may lead to intracranial hemorrhage after IV rtPA thrombolysis. ⋯ Screening to identify patients at risk for development of hemorrhagic complications from underlying structural vascular lesions before the use of IV rtPA with computed tomography angiography should be considered.