Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2005
Comparative StudyDBS therapy for the vegetative state and minimally conscious state.
Twenty-one cases of a vegetative state (VS) and 5 cases of a minimally conscious state (MCS) caused by various kinds of brain damage were evaluated neurologically and electrophysiologically at 3 months after brain injury. These cases were treated by deep brain stimulation (DBS) therapy, and followed up for over 10 years. The mesencephalic reticular formation was selected as a target in 2 cases of VS, and the CM-pf complex was selected as a target in the other 19 cases of VS and 5 cases of MCS. ⋯ DBS therapy may be useful for allowing patients to emerge from the VS, if the candidates are selected according to appropriate neurophysiological criteria. Also, a special neurorehabilitation system may be necessary for emergence from the bedridden state in the treatment of VS patients. Further, DBS therapy is useful in MCS patients to achieve consistent discernible behavioral evidence of consciousness, and emergence from the bedridden state.
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Acta Neurochir. Suppl. · Jan 2005
Controlled Clinical TrialGlucose metabolism in traumatic brain injury: a combined microdialysis and [18F]-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) study.
Following traumatic brain injury, as a consequence of ionic disturbances and neurochemical cascades, glucose metabolism is affected. [18F]-2-Fluoro-2-deoxy-D-glucose (FDG) Positron Emission Tomography (FDG-PET) provides a measure of global and regional cerebral metabolic rate of glucose (rCMRglc), but only during the time of the scan. Microdialysis monitors energy metabolites over extended time periods, but only in a small focal volume of the brain. Our objective in this study is to assess the association of parameters derived from these techniques when applied to patients with traumatic brain injury. ⋯ There were significant relations between rCMRglc and dialysate lactate (r = 0.58, P = 0.04); pyruvate (r = 0.57, P = 0.04), L/G (r = 0.55, P = 0.05), and the P/G (r = 0.56, P = 0.05) but not between rCMRglc and dialysate glucose, L/P or glutamate in this data set. The results suggest that increases in glucose utilization as assessed by FDG-PET in these patients albeit in mainly healthy tissue are associated with increases in dialysate lactate, pyruvate, L/G and the P/G ratio perhaps indicating a general rise in metabolism rather than a shift towards non-oxidative metabolism. Further observations are required with regions of interest (microdialysis catheters positioned) adjacent to mass lesions notably contusions.
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Acta Neurochir. Suppl. · Jan 2005
Association between outcome, cerebral pressure reactivity and slow ICP waves following head injury.
To investigate the relationships between slow vasogenic waves ('B waves') of intracranial pressure (ICP), pressure-reactivity and outcome after traumatic brain injury. ⋯ Inadequate pressure-reactivity and low magnitude of slow vasogenic waves of ICP are associated with fatal outcome after head injury. Based on brain monitoring data, differentiation between favourable outcome and severe disability is more problematic than differentiation between survivors and non-survivors.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialBasilar bifurcation aneurysms. Lessons learnt from 40 consecutive cases.
Basilar bifurcation aneurysms are lately treated frequently with endovascular technique. Microsurgical clipping occlusion technique has, however, still its solid position because of its completeness. ⋯ The authors suggest following strategies and tactics for safe and secure occlusion of aneurysms of this location: pterional approach, selective extradural anterior clinoidectomy SEAC, no transection of the posterior communicating artery, isolation of perforating arteries at the time of neck clipping with oxycellulose and combination of the use of fenestrated clip and conventional clip (especially for aneurysms projected posteriorly), controlled hypotension (systolic pressure of around 100 mmHg), temporary clipping (trapping) procedures of usually less than 15 min. All these are aimed for prevention of intraoperative premature rupture, and of injury of perforating arteries and for complete occlusion of aneurysms in the narrow depth of the operative field.
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Acta Neurochir. Suppl. · Jan 2005
Clinical TrialMicro-endoscopic-discectomy (MED) for far lateral disc herniation in the lumbar spine. Technical note.
This study describes a new experience of the authors in the treatment of extraforaminal disc herniation via the micro-endoscopic far lateral approach to establish a less traumatic approach to extraforaminal disc herniation with less stay in hospital and less cost. Seventeen patients who underwent surgery for extraforaminal disc herniation were analysed and long-term follow up was done revisiting all of them in hospital. The results of surgical decompression via the micro-endoscopic far lateral approach were good in all patients with minimal discomfort. ⋯ Dysesthesia subsided after 2-3 weeks. Extraforaminal disc herniation can be diagnosed with the aid of CT scan and MRI. The minimally invasive surgical treatment via the micro-endoscopic far lateral approach, in our initial experience, has a high rate of succes.