World Neurosurg
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Surgery is a well-established and safe treatment option for focal drug resistant epilepsy. However, difficulties are often encountered in diagnosing mesial cortical lesions. The aim of this study was to evaluate the usefulness and overall complication rate of subdural interhemispheric electrodes (IHEs) as part of an invasive presurgical evaluation of epilepsy patients. ⋯ Implantation of IHE for the preoperative evaluation of epilepsy patients is an established surgical procedure with an acceptable complication profile. The benefits delivered from IHE can positively influence final seizure outcome in the challenging group of extratemporal resections due to interhemispheric lesions. Thus IHEs demonstrate a useful diagnostic utility for the presurgical evaluation of selected epilepsy patients.
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Brain mapping is considered an important approach in neurosurgery to achieve better functional outcomes. The mirror neuron system (MNS) is a brain network implicated in understanding of action and imitation. No previous study has focused on identifying and monitoring the function of the MNS during the perioperative period in brain lesions. The aim of this study was to describe the application of a functional magnetic resonance imaging (fMRI) protocol to identify the MNS in a patient with a lesion in the premotor region. ⋯ The use of an fMRI protocol with observation and execution conditions based on simple intransitive finger actions allows the easy identification and preservation of the MNS. Increased activity on postoperative fMRI may be associated with improvement in motor functions.
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Endovascular techniques have gained importance in recent years in the treatment of acutely ruptured aneurysms. Sometimes artificial anticoagulation or antiplatelet agents are indicated after endovascular aneurysm occlusion to prevent thromboembolic complications. Because many patients require ventriculostomy secondary to hydrocephalus, we analyzed ventriculostomy-related hemorrhage in patients with and without anticoagulant therapy. ⋯ Patients receiving endovascular treatment were at higher risk for ventriculostomy-related hemorrhage, especially when anticoagulation was administered after aneurysm occlusion. Although no clinically relevant external ventricular drain-related hemorrhage occurred, ventriculostomy should be performed before anticoagulation whenever possible.
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Magnesium (Mg) is an essential element for the body's normal physiological functioning. It has a major role in modulating vascular smooth muscle tone and peripheral arterial resistance. A low serum Mg level on admission (HMg0) has been associated with more severe presentation in patients with subarachnoid hemorrhage. However, data on HMg0 specifically in relation to intracerebral hemorrhage (ICH) are scarce. We sought to determine the incidence and clinical significance of HMg0 in patients with ICH. ⋯ HMg0 occurs in one third of patients with ICH and is associated with more severe presentation and intraventricular hemorrhage. Mg levels on admission correlate inversely with systolic BP and directly with GCS scores at presentation. HMg0 does not influence outcomes at discharge.
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Comparative Study
Different Surgical Approaches for the Spinal Schwannoma: A Single Surgeon's Experience with 49 Consecutive Cases.
Comparing different surgical approaches for spinal schwannoma, the safety and efficacy of the minimally invasive surgery (MIS) approach were demonstrated, and a suitable indication for each surgical approach was analyzed. ⋯ Safe and complete resection of intradural extramedullary schwannoma was obtained through the MIS approach. Regardless of sagittal extension of the tumor, a schwannoma with an axial diameter of 16 mm located in the lumbar spine can be effectively treated with the MIS approach, including foraminal extension.