World Neurosurg
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Observational Study
Post Cranioplasty Quantitative Assessment Of Intracranial Fluid Dynamics And Its Impact On Neurocognition "Cranioplasty Effect -A Pilot Study".
This study was done to evaluate the effects of cranioplasty on cerebrohemodynamics (cerebral blood flow [CBF] and mean transient time [MTT]) and cerebrospinal fluid (CSF) hydrodynamics (flow velocities) by using computed tomography perfusion and cardiac-gated cine phase magnetic resonance imaging (MRI) (phase contrast [PC] MRI), respectively. It also aims to determine the co-relation between changes in CBF, MTT, and CSF flow dynamics with neurocognitive outcome. ⋯ Cranioplasty can remarkably improve cortical perfusion for both the ipsilateral and contralateral hemispheres. Postoperative increased CSF velocities suggest improved rapid turnover of CSF in a circuit and possibly play a role in good neurologic outcome. Our study shows there is improvement in CSF flow at the aqueduct of Sylvius after cranioplasty. We propose that improvement in CSF circulation along with changes in CBF co-relate well with cognitive outcome (Montreal Cognitive Assessment score).
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With application of 3T magnetic resonance imaging (MRI) to functional neurosurgery procedures and given the inherent requirement of millimetric precision, the need to develop a method for correction of geometric image distortion emerged. The aim of this study was to demonstrate clinical safety and practical viability of a correction protocol in patients scheduled to undergo stereotactic procedures using 3T MRI. ⋯ The proposed method can satisfactorily correct geometric distortions in clinical 3T MRI studies. Clinical use of the technique can be practical and efficient after software automation of the process. The method can be applied to all spin-echo MRI sequences.
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Large intradural growth of tympanojugular paragangliomas (TJ-PGs) into the cerebellopontine angle is an infrequent condition that can determine an extensive involvement of vessels and brainstem, representing a surgical challenge. The current classifications lack accuracy for defining large intradural TJ-PGs and assessing their operability. This study aims to retrospectively reappraise the management of a large intradural TJ-PGs surgical series, discussing operability criteria, treatment strategies, and resection techniques. ⋯ Large intradural TJ-PGs can be effectively surgically managed with an appropriate technique combined with relevant nonsurgical strategies. Thus, operability criteria for these lesions can be extended. To share objective experience on large intradural TJ-PGs, a redefinition of Di3 tumors is recalled.
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Different tumors can be encountered in the paraventricular regions, and whereas their deep location often make them difficult to access surgically, they may be amenable to chemotherapy and/or radiotherapy. Therefore, tumor biopsy and histologic diagnosis are mandatory to optimize treatment. Different technical procedures have been recommended; the neuroendoscopic approach is accepted and widely used, in particular with an enlarged ventricular system. ⋯ We define a neuroendoscopic intraoperative ultrasound technique. The main advantages of this technique are the identification of the tumor that may not been clearly identified underneath the ventricular ependymal through the neuroendoscopic window alone, and furthermore, that this technique gives the possibility to detect the depth of the needle advance∖ment in the selected tissue while labeling the lesion beneath the ventricular ependyma. Moreover, intraoperative ultrasonography can reveal in a real-time fashion intracranial hemorrhages that may occur after tissue biopsy, therefore providing a useful tool to achieve valid and directed hemostasis when needed.
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Observational Study
Activation of blood coagulation after aneurysmal subarachnoid haemorrhage: a prospective observational trial by rotational thromboelastometry (ROTEM®).
Aneurysmal subarachnoid hemorrhage (aSAH) has been reported to actuate blood coagulation. Rotational thromboelastometry (ROTEM) is a dynamic hemostatic test that can differentiate various coagulation abnormalities. For example, increased coagulation activity can be detected as a wider amplitude of tracing (maximal clot firmness [MCF]). ROTEM had not been used to evaluate coagulation changes after aSAH. We evaluated the on-going coagulation process in patients with aSAH in a prospective, observational study to compare their ROTEM assay results with the control values obtained from patients undergoing clipping of nonruptured aneurysms. ⋯ Blood coagulation is activated at 72 hours after aSAH onset, which can be detected by ROTEM EXTEM-MCF analysis. Also, the FIBTEM-MCF was elevated, implying that the relative contribution of fibrin formation and fibrin polymerization is essential.