Acta neurochirurgica
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Acta neurochirurgica · Apr 2012
Intraoperative MRI and endocrinological outcome of transsphenoidal surgery for non-functioning pituitary adenoma.
Transsphenoidal surgery guided by intraoperative MRI (iMRI) is related to higher rates of tumour resection. The influence of iMRI on endocrinological outcome is still unclear. This study evaluates the endocrinological outcome of iMRI-guided transsphenoidal surgery. ⋯ The use of iMRI in transsphenoidal surgery for non-functioning pituitary adenoma might lead to higher total resection rates. In our series, resection of remnants detected by iMRI was neither associated with higher incidences of postoperative hypopituitarism nor with lower recovery rates of pituitary axes.
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Acta neurochirurgica · Apr 2012
Clinical TrialAwake surgery for incidental WHO grade II gliomas involving eloquent areas.
WHO grade II glioma (G2G) is a pre-malignant tumor, usually revealed by seizures in young patients living normal lives. G2G grows constantly and will inevitably become anaplastic. Surgical resection significantly increases the overall survival by delaying malignant transformation. Recently, a similar natural history was demonstrated in a patient with incidental G2G, with continuous growth and risk of anaplasia. Here, the aim was to study for the first time the functional results and extent of resection in a prospective series of patients who underwent resection for incidental G2G within eloquent areas. ⋯ These results show that surgery can be considered in incidental G2G, even in critical areas, with a minimal risk and optimal resection, thanks to intraoperative mapping. Such findings raise the question of an early detection.
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Acta neurochirurgica · Apr 2012
The release of S-100B and NSE in severe traumatic head injury is associated with APOE ε4.
In this article we tested the hypothesis that the level of two biochemical markers of brain injury may be associated with the apolipoprotein E (APOE) ε4 allele. ⋯ Our data indicate that there might be a gene-induced susceptibility to severe traumatic brain injury and that patients with the APOE ε4 allele may be more predisposed to brain cellular damage measured as S-100B and NSE. Thus, it seems to be of importance to consider the APOE genotype in interpreting the levels of the biomarkers.
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Acta neurochirurgica · Apr 2012
Clinical TrialEndoscopic endonasal removal of laterally extended clival chordoma using side-viewing scopes.
The transsphenoidal approach provides a straight and direct route to the clival chordoma, but has limitations for removing the tumor compartment extending laterally into the space posterior to the paraclival internal carotid artery. To overcome the limitations, a side-viewing endoscope and malleable/steerable instruments were employed. ⋯ Though a longer follow-up is needed to evaluate its effectiveness in long-term tumor control, the surgical maneuver using the side-viewing endoscope is effective for removing laterally extended clival chordomas.
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Acta neurochirurgica · Apr 2012
Impact of antibiotic-impregnated catheters on the timing of cerebrospinal fluid infections in non-traumatic subarachnoid hemorrhage.
Subarachnoid hemorrhage (SAH) has been recognized as a risk factor for ventriculostomy-related infections (VRI). In addition to the hemorrhagic cerebrospinal fluid (CSF), the potential need for prolonged catheterization may contribute to the increased CSF infection rate in this population. The use of antibiotic-impregnated catheters (AIC) has effectively reduced the risk of VRI. Herein, we examined specifically the impact of systematic insertion of AIC on the timing of CSF infections in SAH patients. ⋯ In the high-risk population of non-traumatic SAH, the use of AIC delays the occurrence of infection compared with that reported with non-antibiotic-impregnated catheters. This may orient management strategies in SAH patients requiring a ventriculostomy.