Acta neurochirurgica
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Acta neurochirurgica · Aug 2011
ReviewSurgical management of glioneuronal tumors with drug-resistant epilepsy.
In this review, we discuss the options for the surgical management of glioneuronal tumors (GNTs) associated with drug-resistant epilepsy, with an emphasis on the surgical issues involved in addressing the epileptogenic nature of these lesions. We briefly summarize the pathological hallmarks of these lesions in order to outline how these tumors contribute to seizure activity. Understanding the pathophysiology of these lesions is important in discussing the advantages and disadvantages of different surgical strategies. There have been a number of studies that have investigated the utility of different surgical approaches in improving seizure outcome, and we highlight some of these studies in order to shed light on surgical issues related to these tumors.
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Acta neurochirurgica · Aug 2011
Comparative StudyGenu of corpus callosum in diffuse axonal injury induces a worse 1-year outcome in patients with traumatic brain injury.
Previous studies have shown a relationship between diffuse axonal injury (DAI) and unfavorable clinical outcome in patients with traumatic brain injury (TBI), but it remains unclear whether the type of DAI lesion influences outcome after TBI. The aim of the present study was to investigate whether 1-year outcome after TBI differed between patients with different types of lesions. ⋯ CC lesions, especially those in the genu, were related to unfavorable 1-year outcome in patients with TBI.
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Acta neurochirurgica · Aug 2011
Case ReportsImprovement of hand dexterity induced by stimulation of the peduncolopontine nucleus in a patient with advanced Parkinson's disease and previous long-lasting bilateral subthalamic DBS.
We report the case of a patient already submitted to bilateral deep-brain stimulation (DBS) of the subthalamic nucleus (STN) who started to develop gait impairment, postural imbalance and frequent falls in the course of the disease and who subsequently underwent DBS of the right pedunculopontine nucleus (PPN) at our institute. An immediate clinical benefit in hand dexterity was observed with acute external stimulation and maintained after the definitive implant of the internal pulse generator (IPG) at 6 months' follow-up. The benefit on hand dexterity seemed to be related to the interactions between the PPN low-frequency stimulation and the bilateral STN high-frequency stimulation.
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Acta neurochirurgica · Aug 2011
Computed tomography-guided γ knife stereotactic radiosurgery for trigeminal neuralgia.
Gamma knife stereotactic radiosurgery (GKSR) is an effective minimally invasive option for the treatment of medically refractory trigeminal neuralgia (TN). Optimal targeting of the retrogasserian trigeminal nerve target requires thin-slice, high-definition stereotactic magnetic resonance imaging (MRI). The purpose of this study was to evaluate management outcomes in TN patients ineligible for MRI and who instead underwent GKSR using computed tomography (CT). ⋯ CT-guided GKSR provides a similar rate of pain relief as MRI-guided radiosurgery. The posterior pins should be placed at least 1 cm away from the inion to reduce pin and frame-related artifacts on the targeting CT scan. This study indicates that GKSR using CT targeting is appropriate for patients with medically refractory TN who are unsuitable for MRI.
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Acta neurochirurgica · Aug 2011
The possible role of neuropeptide Y after spontaneous subarachnoid hemorrhage.
Neuropeptide Y (NPY), a highly potent vasoconstrictive neuropeptide, is widely expressed in the human brain, regulating vessel diameter and cerebral blood flow. Earlier studies focusing on the possible role of NPY in the context of aneurismal subarachnoid hemorrhage (SAH) and vasospasm have produced conflicting results. However, despite extensive research efforts, the pathophysiological mechanisms underlying the SAH-related vasospasm and delayed cerebral ischemia (DCI) have not been clarified. We, therefore, attempted to investigate the role of NPY in SAH-induced vasospasm in a larger, well documented patient population utilizing modern analytical tools. We focused on the release of the potent vasoconstrictor NPY in cerebrospinal fluid (CSF) and blood, and its correlation to vasospasm and stroke in the early clinical stage. ⋯ NPY is released excessively into blood and CSF following SAH. Patients with cerebral infarction caused by vasospasm had significantly higher levels of NPY. Our results indicate a certain role for NPY in the pathophysiology of vasospasm due to SAH and justify further studies in this area of research.