Neurosurgery clinics of North America
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MRI has become the modality of choice for imaging the peripheral nervous system. When technically optimized and customized for individual clinical problems, MRI can provide insight into the underlying causes of neoplastic, inflammatory, and other diseases affecting peripheral nerves with a high degree of accuracy and effectively distinguish benign from malignant processes. With high-resolution imaging techniques targeted fascicular biopsy can be planned to improve diagnostic yield and decrease the risk of surgically sampling primary nerve pathology.
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Neurosurg. Clin. N. Am. · Apr 2008
Biography Historical Article Classical ArticleIntraoperative monitoring of facial and cochlear nerves during acoustic neuroma surgery. 1992.
Preservation of facial nerve function during acoustic neuroma surgery can be improved significantly by monitoring of facial electromyography (EMG) during surgery. Mechanical trauma during dissection causes EMG activity that can be played over a loudspeaker for direct feedback to the surgeon. Electrical stimulation can be used to locate the nerve even when it is out of direct view, and the threshold for stimulation provides a measure of facial (or other motor nerve) integrity. Cochlear nerve function also can be monitored by the recording of auditory brain stem responses or compound action potentials from an electrode placed on the nerve at the brain stem root entry zone.
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Neurosurg. Clin. N. Am. · Apr 2008
Biography Historical Article Classical ArticleSurgical approaches and complications in the removal of vestibular schwannomas. 2007.
Vestibular schwannomas are benign tumors that usually originate from the balance portion of cranial nerve VIII. The treatment options currently available for vestibular schwannomas include observation with serial imaging, stereotactic radiation, and microsurgical removal. ⋯ Each approach has its advantages and disadvantages. The goal of surgery is complete eradication of tumor with preservation of hearing and facial nerve function when possible.
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Chordomas are the most common primary malignant tumor of the mobile spine and of the sacrum. Although considered not to possess significant metastatic potential, such lesions are locally aggressive, leading to neurologic compromise and lytic destruction of bone. ⋯ Such radical resections may be associated with significant surgical morbidity, however. Although considered generally resistant to radiation therapy and chemotherapy, recent advances in photon and proton radiation therapy and use of monoclonal antibodies may provide improved outcomes for poor surgical candidates and for tumors that recur after surgery.
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Pediatric thoracolumbar spinal trauma is a relatively rare event. It is important to understand the unique mechanical, diagnostic, and management considerations of this patient population. Inadequate recognition of thoracolumbar spinal injuries or suboptimal management may lead to less than ideal clinical outcomes in a population of patients who otherwise would have had great potential for recovery.