Neurosurgery
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We propose a modification to the currently prevailing grading systems in patients with subarachnoid hemorrhage. The changes will make them correlate more strongly with the surgical results. ⋯ To grade patients with subarachnoid hemorrhage objectively, three responses should be recorded separately in the Glasgow Coma Scale score. Patients with confused verbal responses should be graded lower than those who are oriented, even when they have the same total score.
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To demonstrate the feasibility of transcranial high-frequency electrical stimulation with the patient under general anesthesia with propofol and alfentanil. This method may be a useful tool for intraoperative monitoring of the motor pathways during cerebral and spinal operations. ⋯ Transcranial high-frequency repetitive electrical stimulation seems to be a new method for monitoring the motor tract. With this method, it is possible to monitor the motor function without interfering with the surgical team or with the surgical treatment of infratentorial and spinal lesions. Monitoring of relaxation is necessary to compare the amplitude of MEPs.
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To determine the indications for, efficacy of, and safety of depth electrode placement using magnetic resonance imaging (MRI)-guided stereotactic surgery in patients with intractable epilepsy. ⋯ We have found intracerebral electrode placement to be as safe as subdural strip electrode placement and have found combined depth and strip electrode monitoring to be highly effective in localizing the onset zones of complex partial seizures. Intracranial monitoring was particularly useful in the detection of a single ictal onset zone in the absence of neuroimaging abnormality and in the definitive diagnosis of bilateral independent ictal onset zones in the temporal lobe epilepsy syndrome. The specific technical aspects of the procedure that contribute to a successful outcome are reviewed. A comparison with earlier reported series suggests that MRI-guided stereotaxy and pial inspection may reduce complications of depth electrode placement.