Acta neurochirurgica
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Acta neurochirurgica · Sep 2011
Case ReportsMotor-evoked potentials (MEP) during brainstem surgery to preserve corticospinal function.
Brainstem surgery bears a risk of damage to the corticospinal tract (CST). Motor-evoked potentials (MEPs) are used intraoperatively to monitor CST function in order to detect CST damage at a reversible stage and thus impede permanent neurological deficits. While the method of MEP is generally accepted, warning criteria in the context of brainstem surgery still have to be agreed on. ⋯ Adjustment of surgical strategy contributed to good motor outcome in 33/39 patients. MEP monitoring may help significantly to prevent motor deficits during demanding neurosurgical procedures on the brainstem.
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Acta neurochirurgica · Sep 2011
Clinical TrialResection frequency map after awake resective surgery for non-lesional neocortical epilepsy involving eloquent areas.
The resection of eloquent areas is challenging due to postoperative neurological deficits. The purpose of this study was to assess the efficacy and risk of awake brain surgery for non-lesional epilepsy involving the eloquent areas or their adjacent areas and to advocate the generation of a resection frequency map. ⋯ Awake resective surgery with intraoperative brain mapping is an effective and safe treatment option for non-lesional epilepsy involving eloquent areas. The resection frequency map can show the resected area of a group as well as individuals and provide an objective measure of neurological risk.
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Acta neurochirurgica · Sep 2011
Immediate diagnosis of ventriculits: evaluation of parameters independent of microbiological culture.
Generally accepted reference values in CSF diagnostics are not valid in cerebrospinal fluid (CSF) containing large amounts of blood. Residual blood may obscure ventriculitis as diagnostics largely depend on parameters such as cell count, lactic acid and total protein measurement. We sought to improve the diagnostics by evaluating a cytokine panel and soluble CD62L as markers of ventriculitis. In addition, we tested an algorithm of established parameters to predict ventriculitis in a specific patient collective. ⋯ IL1-beta and perhaps also IL8 provide very good analytical performance when looking for ventriculitis in patients with residual blood in CSF. Turn-around time is short, and results could be reported within 1 h for 24 h a day. In some patients application of glucocorticoids may result in restricted inflammatory response. Even in these patients IL1-beta provides a reliable parameter for the immediate diagnosis of ventriculitis.
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Acta neurochirurgica · Sep 2011
Stereotactic LINAC radiosurgery for incompletely resected or recurrent atypical and anaplastic meningiomas.
The optimal management of subtotally resected or recurrent malignant meningiomas remains controversial. We evaluated the efficacy of linear accelerator (LINAC) radiosurgery for atypical and anaplastic meningiomas after incomplete resection or treatment of recurrences. ⋯ Our results show the efficacy and safety of LINAC radiosurgery for incompletely resected or recurrent malignant meningiomas with a relatively high local tumor control and low morbidity.
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Acta neurochirurgica · Sep 2011
Middle turbinate vascularized flap for skull base reconstruction after an expanded endonasal approach.
The expanded endonasal approaches to the skull base are modular approaches that arise from the sphenoidal sinus. The reconstructive techniques in these approaches are key to avoid postoperative complications. Available flaps for reconstruction include the pedicled nasoseptal flap, the transpterygoid temporoparietal fascia flap, and the posterior pedicle inferior turbinate flap (PPITF), among others. Recently, the middle turbinate flap has been described in a cadaveric study. We report our preliminary experience in the use of this middle turbinate vascularized flap for skull base reconstruction after expanded endonasal approaches. ⋯ The vascularized middle turbinate flap is a reliable reconstructive technique for the reconstruction of moderate-sized skull base defects. It can be considered either as the first choice of closure or as an alternative to the nasoseptal flap when this is not available. Different flap combinations may facilitate skull base defect reconstruction.