World Neurosurg
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Case Reports
Concurrent Schwannoma and Intraneural Ganglion Cyst Involving Branches of the Common Peroneal Nerve.
Benign peripheral nerve sheath tumors are well known to neurosurgeons and a relatively commonly seen pathology. Intraneural ganglion cysts, once thought to be rare and poorly understood, are increasingly recognized in clinical practice and better understood based on the advent of high-resolution imaging. ⋯ Herein we present a patient with 2 distinct pathologies explaining 2 distinct symptom complexes-sensory changes in the superficial peroneal distribution (from a schwannoma of the superficial peroneal nerve) and mild motor weakness in the tibialis anterior (from an intraneural ganglion cyst arising from the superior tibiofibular joint affecting this motor branch). Recognition of the 2 pathologies allowed targeted surgical approaches, which led to resolution of the symptoms.
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Diffuse axonal injury (DAI) is a common form of primary head injury. This study was done to see the association of DAI grades with extended Glasgow Outcome Scale (GOSE). ⋯ Mean GCS at presentation is a better predictor of outcome after DAI rather than its grade.
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The effect of intoxicating substances on assessment of Glasgow Coma Scale (GCS) in the trauma setting has not been completely elucidated. ⋯ Intoxicating substances can confound GCS assessment in trauma patients. This can have effects on patient care as well as performance metrics and predictive analytics. These patients should be screened, and intoxicating substances should be reversed or allowed to wear off before GCS score is recorded for benchmarking or quality reporting.
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The need for a better understanding of the subthalamic nucleus (STN)'s vascular anatomy is still evident because revealing its vascular supply may increase insight in the pathogenesis of related disorders, such as STN ischemia. The mechanisms under motor, behavioral, and cognitive changes following deep brain stimulation treatment may also be explained by its pattern of vascularization. The primary goal of this study was to delineate the vascularization of the STN and highlight the predominant perforating arteries supplying its territory. ⋯ The 3-dimensional microsurgical anatomy of the deep-seated STN region is complex, and the additional knowledge on its vascularization should improve our understanding of its surgical anatomy.
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Pharmacologically induced electroencephalogram (EEG) silence increases tolerance of ischemic period by reducing cerebral metabolism. We hypothesized that sevoflurane, a cerebral vasodilator, will maintain cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) better than propofol, a cerebral vasoconstrictor, during EEG silence. To validate this, we compared the effect of sevoflurane and propofol on CBF and CMRO2 during surgical plane of anasthesia (SP) and burst suppression on EEG (BS). ⋯ In our study, sevoflurane had a safer profile on cerebral oxygenation during BS while not altering the CBF, suggesting increased availability of oxygen. Propofol, on the other hand, produced cerebral vasoconstriction with BS. The effect of propofol on oxygenation was unpredictable, with low SjvO2 and high AjvDO2 even at surgical plane of anesthesia.