World Neurosurg
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Electrocortical stimulation (ECS) is the gold standard for functional brain mapping during an awake craniotomy. The critical issue is to set aside enough time to identify eloquent cortices by ECS. High gamma activity (HGA) ranging between 80 and 120 Hz on electrocorticogram is assumed to reflect localized cortical processing. In this report, we used real-time HGA mapping and functional neuronavigation integrated with functional magnetic resonance imaging (fMRI) for rapid and reliable identification of motor and language functions. ⋯ This novel technique enables rapid and accurate identification of motor and frontal language areas. Furthermore, real-time HGA mapping sheds light on underlying physiological mechanisms related to human brain functions.
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Clinical Trial
Increased survival using delayed gamma knife radiosurgery for recurrent high-grade glioma: a feasibility study.
The current study retrospectively assessed delayed gamma knife radiosurgery (GKRS) in the management of high-grade glioma recurrences. ⋯ The current study shows a survival benefit for high-grade glioma recurrences when GKRS was administered after standard therapy. This is a relevant improvement compared with earlier studies that had had not been able to provide a beneficial effect timing radiosurgery in close vicinity to EBRT.
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Clinical Trial
Unilateral endoscopic optic nerve decompression for idiopathic intracranial hypertension: a series of 10 patients.
Several surgical treatment modalities, including lumboperitoneal or ventriculoperitoneal shunt surgery, subtemporal decompression, endovascular venous sinus stenting, optic nerve decompression (OND), were used in the management of idiopathic intracranial hypertension (IIH). Each surgical technique has different advantages and disadvantages. Endoscopic OND is rarely used in the management of IIH. There are only four reported cases. The aim of this study is to describe the surgical results of patients treated with this less invasive surgical technique. ⋯ The surgical treatment of IIH by using the unilateral endoscopic OND technique is a safe and effective method in the hands of experienced surgeons with advanced endoscopic skills. A collaboration with the ophthalmology team is needed for the follow-up. Further studies with larger patient numbers is needed to compare unilateral endoscopic OND technique with the current techniques used in the surgical management of IIH.
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Case Reports Comparative Study
Surgical versus nonsurgical treatment of subaxial cervical pedicle fractures.
Pedicle fractures in the cervical spine are common. They may occur in isolation or in combination with other concomitant fractures. Multiple classification systems have been introduced to provide a clinical framework when approaching these types of fractures; however, these systems do not provide guidelines for optimal treatment. Data regarding decision making are limited. Conservative treatment with orthoses may result in subluxation and instability requiring further treatment. Surgery may not be required in all instances because many of these injuries may heal without surgical intervention. ⋯ This study describes and classifies unique cervical pedicle fractures and associated injuries. Our findings suggest that surgical treatment results in definitive stability for these injuries compared with conservative therapy, particularly for pedicle fractures associated with comminuted lateral mass or initially displaced fractures. However, nondisplaced vertical split pedicle fractures and isolated single line horizontal fractures may be treated nonsurgically without occurrence of further instability. A larger prospective study is required to confirm these findings.
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Postthrombolytic intracerebral hemorrhage (ICH) is an infrequent occurrence in patients with acute ischemic stroke. There is controversy surrounding the value of neurosurgical treatment of symptomatic hematomas in these patients and whether availability of neurosurgical treatment is a necessary prerequisite for administration of thrombolytic agents. We report the frequency and outcomes of patients who undergo craniotomy for postthrombolytic ICH. ⋯ Emergent craniotomy for postthrombolytic ICH in patients with acute stroke is a salvage treatment offered to a small proportion of patients. Although biases introduced by patient selection cannot be excluded in our analysis, the excessively high rates of death or disability associated with surgical evacuation limit the value of such a procedure in current practice.