Neurosurgery
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To assess feasibility and clinical value of motor evoked potential (MEP) monitoring with surgery close to supratentorial motor areas and pathways. ⋯ MEP monitoring with supratentorial surgery is feasible and safe. It may help to maximize resection within the limits of preserved motor function. Further evidence is needed to confirm these results.
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Comparative Study
Prevention of pulmonary embolism by combined modalities of thromboprophylaxis and intensive surveillance protocol.
Deep vein thrombosis (DVT) is a known complication in neurosurgical patients. The protocols for the prevention of DVT and pulmonary embolism (PE) are not applied universally. Our goal was to review the incidence of DVT and PE in neurosurgical intensive care units (NSICUs) and to compare it with the incidence of DVT and PE in other intensive care units (ICUs) in the same hospital. ⋯ We conclude that there was a significantly lower incidence of DVT and PE in the NSICU than in all other ICUs at our institution. DVT prophylaxis and twice-weekly lower-extremity venous Doppler screening in the NSICU have been found to be beneficial in decreasing the incidence of DVT and particularly effective in preventing PE.
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Case Reports
A combined subtemporal and transventricular/transchoroidal fissure approach to medial temporal lesions.
To minimize therapeutic morbidity such as cognitive function disturbance and vascular injury to perforating arteries, preoperative functional mapping of the basal temporal lobe functions was performed and the medial temporal lesions were resected via a combined subtemporal and transventricular/transchoroidal fissure approach. ⋯ Surgeons can confirm the important neurovascular structures from the subtemporal route and from the transtemporal horn route by a combined subtemporal and transventricular/transchoroidal fissure approach. This approach is especially effective for avoiding ischemic complications by allowing direct confirmation of the anterior choroidal and thalamoperforating arteries.
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The carotid-oculomotor window remains the traditional deep window in the exposure of aneurysms of the upper basilar artery. Although several techniques have been described to expand this window, few morphometric studies document either the degree of its expansion or its contribution to the exposure of the basilar artery. We review the microsurgical anatomy of the carotid-oculomotor window, describe expansion techniques, and analyze morphometrically the contribution of each step (i.e., extradural anterior clinoidectomy, mobilization of the internal carotid artery [ICA], and posterior clinoidectomy) to the expansion of the window and/or exposure of the artery. ⋯ Anterior clinoidectomy and ICA mobilization increased the carotid-oculomotor space 44% anteriorly and 28% posteriorly. Posterior clinoidectomy increased the exposed length of the basilar artery by 69%. Superficial wide field exposure, expansion of the carotid-oculomotor window, and increased exposure of the upper basilar artery facilitate both visualization of the aneurysm for clip application and the use of proximal vascular control as an adjunct to basilar aneurysm surgery.
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Cerebral ischemia is a common secondary sequela of traumatic brain injury (TBI). Experimental models of stroke have demonstrated reductions in ischemia after perfluorocarbon (PFC) administration; however, there are no published reports of PFC efficacy after TBI. The current study analyzed the effect of the PFC emulsion Oxygent (AF0144; Alliance Pharmaceutical Corp., San Diego, CA) on cerebral oxygenation, mitochondrial redox potential, and free radical formation after lateral fluid percussion injury. ⋯ The current study demonstrates that a PFC emulsion can significantly increase cerebral oxygenation after TBI and enhance mitochondrial function at 4 hours after injury as compared with saline. This study demonstrates a new therapeutic potential for PFC to enhance cerebral oxygenation and aerobic metabolism after TBI. However, the increased free radical formation with high-dose PFCs suggests the need for further studies combining PFCs with free radical scavengers.