Acta neurochirurgica
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Acta neurochirurgica · Feb 2005
Case ReportsSuccessful resection of a left insular cavernous angioma using neuronavigation and intraoperative language mapping.
Despite recent literature advocating the surgical removal of symptomatic Cavernous Angiomas (CA), even in critical brain areas, very few observations of insular CA surgery have been described, particularly in the left hemisphere. We report the case of a successful resection of a CA located in the dominant insula, using both neuronavigation and intra-operative functional mapping. This 33-year-old right-handed man harbored a left insular CA, revealed by generalized seizures following a bleed confirmed on MRI. ⋯ There was no postsurgical deficit, nor any seizure without treatment (follow-up: 4.5 years). The diagnosis of CA was confirmed by histological examination. Taking account of the risk of morbidity due to the natural history of CA, particularly in eloquent brain regions, we suggest to routinely consider the possibility of a surgical treatment in cases of symptomatic (left dominant) insular CA, using combined intra-operative anatomical and physiological localization methods.
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Acta neurochirurgica · Feb 2005
Microsurgical anatomy of the dorsal cervical rootlets and dorsal root entry zones.
Detailed anatomical knowledge of the dorsal cervical rootlets and dorsal root entry zones (DREZ) is important for the diagnosis and treatment of cervical myeloradiculopathy and surgical management of pain. There are far fewer micro-anatomical studies of this area than gross anatomical studies. This study presents several anatomical points regarding the dorsal cervical rootlets and dorsal root entry zones. ⋯ The distance from the midline to the DREZ decreased in the lower cervical spine. The longest longitudinal length of the DREZ was at the C5 level. The length of the dorsal rootlets was increased in the lower cervical spine. The average number of dorsal rootlets tended to increase in the lower cervical spine. Anastomoses were most often found between C6-7 and C5-6 dorsal rootlets. Knowledge of the anatomical features of dorsal cervical rootlets and dorsal root entry zones is essential for a surgeon to avoid injuring the neural structures. This knowledge is a must not only to avoid complications but also for the success, safety and effectiveness of microsurgical operations of the pathological conditions like posterior myeloradiculopathy and pain treatment such as DREZ operations.
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Acta neurochirurgica · Feb 2005
Image guided interstitial laser thermotherapy: a canine model evaluated by magnetic resonance imaging and quantitative autoradiography.
To determine the applicability and safety of a new canine model suitable for correlative magnetic resonance imaging (MRI) studies and morphological/pathophysiological examination over time after interstitial laser thermotherapy (ILTT) in brain tissue. ⋯ ILTT causes transient, highly localised areas of increased capillary permeability surrounding the laser lesion. Phase contrast imaging for MRI thermomonitoring can currently not be used for reliable temperature readings in vivo. The suggested new canine model proved to be safe, accurate, easy to use, and provides clinical, radiographic, pathological and physiological correlations.