Acta neurochirurgica
-
Acta neurochirurgica · Jun 2015
Tractography of Meyer's loop for temporal lobe resection—validation by prediction of postoperative visual field outcome.
Postoperative visual field defects are common after temporal lobe resection because of injury to the most anterior part of the optic radiation, Meyer's loop. Diffusion tensor tractography is a promising technique for visualizing the optic radiation preoperatively. The aim of this study was to assess the anatomical accuracy of Meyer's loop, visualized by the two most common tractography methods—deterministic (DTG) and probabilistic tractography (PTG)—in patients who had undergone temporal lobe resection. ⋯ Both DTG and PTG could predict the degree of visual field defects. However, PTG was superior to DTG in terms of reproducibility and anatomical accuracy. PTG is thus a strong candidate for presurgical planning of temporal lobe resection that aims to minimize injury to Meyer's loop.
-
Acta neurochirurgica · Jun 2015
Incidence of local in-brain progression after supramarginal resection of cerebral metastases.
Microsurgical circumferential stripping of intracerebral metastases is often insufficient in achieving local tumor control. Supramarginal resection may improve local tumor control. ⋯ Supramarginal resection of cerebral metastases in eloquent locations is feasible and safe. Safety might be increased by intraoperative neuromonitoring. The better outcome in the present series may be entirely based on other predictors than extend of surgical resection and not necessarily on the surgical technique applied. However, supramarginal resection was safe and apparently did not lead to worse results than regular surgical techniques. Prospective, controlled, and randomized studies are mandatory to determine the possible benefit of supramarginal resection on local tumor control and overall outcome.
-
Acta neurochirurgica · Jun 2015
Intraoperative functional mapping of calculation in parietal surgery. New insights and clinical implications.
Parietal areas play a crucial role in calculation processing. The purpose of this study is to report our experience in the assessment of calculation processing during awake surgery in parietal areas, focusing on clinical implications and new insights provided by this approach. ⋯ Our findings support the specificity of the reported technique in the intraoperative identification of sites functional for calculation. Our data show the bilateral involvement of parietal cortex, especially of the inferior lobule, in calculation processing. Furthermore, our study suggests the existence of a sub-cortical pathway specific for calculation, whose better understanding might be crucial for the clinical outcome of patients.
-
Acta neurochirurgica · Jun 2015
Intraoperative cerebral angiosonography with ultrasound contrast agents: how I do it.
Intraoperative vessel visualization is highly desirable, especially when the target is related to or close to main vessels, such as in the skull base and vascular surgery. Contrast-enhanced ultrasound (CEUS) is an imaging technique that allows visualization of tissue perfusion and vascularization through the infusion of purely intravascular ultrasound contrast agents (UCA). ⋯ Real-time intraoperative ASG is a rapid, reliable, repeatable method for vessel visualization and evaluation of tissue perfusion.
-
Acta neurochirurgica · Jun 2015
Randomized Controlled Trial Comparative StudyPreemptive scalp infiltration with 0.5% ropivacaine and 1% lidocaine reduces postoperative pain after craniotomy.
In order to reduce the consequences of narcotic-related side effects and provide effective analgesia after craniotomy, we conducted a randomized trial to compare the analgesic efficacy of preemptive scalp infiltrations with 1% lidocaine and 0.5% ropivacaine on the postoperative pain. ⋯ Preemptive scalp infiltration with 0.5% ropivacaine and 1% lidocaine provides effective postoperative analgesia after craniotomy.