Neurosurgical review
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Neurosurgical review · Jul 2014
Chronic post-traumatic neuropathic pain of brachial plexus and upper limb: a new technique of peripheral nerve stimulation.
The aim of the study was to evaluate the effect on pain relief in patients with peripheral neuropathic pain after brachial plexus injuries using an implanted peripheral nerve stimulator applied directly to the nerve branch involved into the axillary cavity. Seven patients with post-traumatic brachial plexus lesions or distal peripheral nerve complaining of severe intractable chronic pain were enrolled in a single-centre, open-label trial. Conventional drugs and traditional surgical treatment were not effective. ⋯ No significant adverse events occurred. We recommend and encourage this surgical technique for safety reasons; complications such as dislocation of electrocatheters are avoided. The peripheral nerve stimulation is effective and in severe neuropathic pain after post-traumatic nerve injuries of the upper limbs.
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Neurosurgical review · Jul 2014
Impact of cervical internal carotid clamping and radial artery graft bypass on cortical arterial perfusion pressure during craniotomy.
Strategic cervical internal carotid occlusion is employed either temporarily or permanently in various neurosurgical procedures. The aim of the present study was to assess changes in cortical arterial pressure during cervical internal carotid cross-clamping before and after the placement of radial artery (RA) graft bypass in the treatment of complex carotid artery aneurysms. Perfusion pressure of the middle cerebral artery (MCA) was assessed in 22 patients with complex carotid aneurysm treated with RA graft bypass. ⋯ Postoperative regional cerebral blood flow in the MCA territory on the ipsilateral side of the aneurysm was 97 ± 7 % of that of the contralateral side after internal carotid artery (ICA) ligation combined with RA graft bypass. Substantial pressure reductions in cerebral cortical arteries were observed during the cervical internal carotid cross-clamping. Perfusion pressure in peripheral cortical arteries after the placement of the RA graft bypass was comparable to the state before ICA clamping.
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Neurosurgical review · Apr 2014
The medial cord to musculocutaneous (MCMc) nerve transfer: a new method to reanimate elbow flexion after C5-C6-C7-(C8) avulsive injuries of the brachial plexus--technique and results.
The aim of this paper is to report on our ample experience with the medial cord to musculocutaneous (MCMc) nerve transfer. The MCMc technique is a new type of neurotization which is able to reanimate the elbow flexion in multilevel avulsive injuries of the brachial plexus provided that at least the T1 root is intact. A series of 180 consecutive patients, divided into four classes according to the quality of hand function, is available for a long-term follow-up after brachial plexus surgery. ⋯ Moreover, this technique theoretically offers the possibility of a "second attempt" at a more distal level in case of failure of the first surgery. This procedure is quick, safe, extremely effective and easily feasible by an experienced plexus surgeon. The ideal candidate is a patient harbouring a C5-C6 avulsive injury of the upper brachial plexus with a normally functioning hand.
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Neurosurgical review · Apr 2014
Continuous intraoperative monitoring of abnormal muscle response in microvascular decompression for hemifacial spasm; a real-time navigator for complete relief.
Intermittent monitoring of abnormal muscle response (iAMR) has been reported to be useful for improving the surgical outcome of microvascular decompression (MVD) for hemifacial spasm (HFS). However, iAMR has not elucidated the relationship between AMR change and the corresponding surgical procedure, or the pathogenesis of AMR and HFS. The purpose of this study is to clarify the usefulness of continuous AMR monitoring (cAMR) for improving the surgical results of MVD and for understanding the relationship between AMR change and corresponding surgical procedure, and the pathogenesis of AMR and HFS. ⋯ Facial spasm remained in four patients despite permanent AMR disappearance. cAMR monitoring improves the outcome of MVD. Although the main cause of HFS and AMR is vascular compression at the facial nerve, hyperexcitability of the facial nucleus is also involved in the pathogenesis of HFS and AMR. The proportional involvement of these causes differs between patients.
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Neurosurgical review · Apr 2014
An endoscopic-assisted technique for retrosellar access during the extended retrosigmoid approach: a cadaveric feasibility study and quantitative analysis of retrosellar working area.
The retrosigmoid approach has been advocated for certain petroclival tumors but provides limited access to any retrosellar extension of tumor, necessitating a two-stage operation. Our purpose was to demonstrate preliminary feasibility of an endoscopic-assisted technique to provide retrosellar access during the extended retrosigmoid approach and compare microscopic and endoscopic retrosellar working area. Standard retrosigmoid craniectomy and partial petrosectomy respecting inner ear structures were performed on six embalmed cadaveric heads. ⋯ The described endoscopic-assisted technique can provide retrosellar access during the extended retrosigmoid approach to access petroclival tumors with retrosellar extension. Risks include superior petrosal vein sacrifice, bleeding that can impair visualization, injury to the trigeminal nerve during endoscopic insertion/manipulation or injury to the brainstem while working in the medial limits of exposure. Further work is necessary to determine clinical feasibility, safety, and efficacy.