Acta neurochirurgica
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Acta neurochirurgica · Feb 2010
Clinical TrialRobot-assisted image-guided transcranial magnetic stimulation for somatotopic mapping of the motor cortex: a clinical pilot study.
Shape and exact location of motor cortical areas varies among individuals. The exact knowledge of these locations is crucial for planning of neurosurgical procedures. In this study, we have used robot-assisted image-guided transcranial magnetic stimulation (Ri-TMS) to elicit MEP response recorded for individual muscles and reconstruct functional motor maps of the primary motor cortex. ⋯ Ri-TMS is suitable for high resolution non-invasive preoperative somatotopic mapping of the motor cortex. Ri-TMS may help in the planning of neurosurgical procedures and may be directly used in navigation systems.
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Acta neurochirurgica · Feb 2010
Genes influencing coagulation and the risk of aneurysmal subarachnoid hemorrhage, and subsequent complications of secondary cerebral ischemia and rebleeding.
We investigated whether genes influencing coagulation are associated with the occurrence of aneurysmal subarachnoid hemorrhage (SAH) and with secondary cerebral ischemia and rebleeding in patients with aneurysmal SAH. ⋯ We found that aneurysmal SAH patients are more often carriers of the subunit B His95Arg factor XIII polymorphism compared to controls. This suggests that carriers of the subunit B His95Arg factor XIII polymorphism have an increased risk of aneurysmal SAH. Larger studies should confirm our results. As aneurysmal SAH patients who died soon after admission could not be included in the present study, our results only apply to a population of patients who survived the initial hours after the hemorrhage. For the other studied genetic factors involved in coagulation, no association with the occurrence of aneurysmal SAH or with the occurrence of secondary cerebral ischemia or rebleeding after aneurysmal SAH could be demonstrated.
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Acta neurochirurgica · Feb 2010
Case ReportsCystic craniopharyngioma: trans-sphenoidal surgery and intra-cystic apposition of "bleomycin wax".
The current therapeutic approach to craniopharyngioma is multidisciplinary. Sub-total removal, followed by adjuvant treatments, especially in large cystic tumours, is an accepted regime reported by many authors. ⋯ The intra-operative use of "bleomycin-wax" should be limited to those patients in whom intra-operative CSF fistula does not occur.
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Acta neurochirurgica · Feb 2010
Clinical and surgical features of lower brain stem hemangioblastomas in von Hippel-Lindau disease.
In the context of von Hippel-Lindau disease (VHL), the medulla oblongata is a relatively frequent site of growth of hemangioblastomas, posing related clinical and surgical difficulties. Their management requires a close correlation between clinical evolution and morphological surveillance. In order to describe their clinical and surgical features, we reviewed our experience in the treatment of these lesions. ⋯ Lower brain stem hemangioblastomas in the context of VHL show an often gradual onset of signs and symptoms except for patients who develop an obstructive hydrocephalus. Although transient surgical complications are possible, surgery provides favorable long-term results.
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Acta neurochirurgica · Feb 2010
Case ReportsDirect puncture of a prematurely detached balloon in the supraclinoid ICA via the optic canal during embolisation of a traumatic carotid-cavernous fistula.
We report a patient with traumatic carotid-cavernous fistula associated with an isolated internal carotid artery in whom, after trans-arterial balloon embolisation, premature balloon detachment occurred with balloon migration to the supraclinoid carotid artery, leading to total occlusion of the blood flow. The carotid flow was eventually restored by direct puncture of the detached balloon via the optic canal and by deploying a coronary stent to fix the balloon in the vascular wall. The fistula was eventually occluded by using detachable coils. He was discharged with a mild hemiparesis and decreased acuity in the left eye.