Acta neurochirurgica
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Acta neurochirurgica · Jan 2009
Case ReportsDeep brain stimulation of the posterior subthalamic area in the treatment of tremor.
Several studies have described lesional therapy in the posterior subthalamic area (PSA) in the treatment of various movement disorders. Recently, some publications have illustrated the effect of deep brain stimulation (DBS) in this area in patients with Parkinson's disease, essential tremor, MS-tremor, and other forms of tremor. Even though the clinical series is small, the reported benefits prompted us to explore DBS in this area in the treatment of tremor. ⋯ DBS of the PSA in this small group of patients had an excellent effect on the different forms of tremor, except for the neuropathic tremor where the effect was moderate. These preliminary results suggest PSA to be an effective target for the treatment of various forms of tremor. Further studies concerning indications, safety and efficacy of DBS in the posterior subthalamic area are required.
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Acta neurochirurgica · Jan 2009
Use of a thrombin-gelatin haemostatic matrix in endoscopic endonasal extended approaches: technical note.
The management of intradural bleeding during extended endoscopic endonasal surgery is challenging. This technical note describes the use of a biological haemostatic agent which could be useful when other established strategies and materials are not effective. ⋯ The thrombin-gelatin matrix could represent a valuable tool when other haemostatic strategies are ineffective or suboptimal. It is safe and biocompatible when compared with haemostatic agents currently in use.
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Acta neurochirurgica · Jan 2009
Case ReportsSciatic cross-over in patients with peroneal and tibial intraneural ganglia confirmed by knee MR arthrography.
A predictable mechanism and stereotypic patterns of peroneal intraneural ganglia are being defined based on careful analysis of MRIs. Peroneal and tibial intraneural ganglia extending from the superior tibiofibular joint which extend to the level of the sciatic nerve have been observed leading to the hypothesis that sciatic cross-over could exist. Such a cross-over phenomenon would allow intraneural cyst from the peroneal nerve by means of its shared epineurial sheath within the sciatic nerve to cross over to involve the tibial nerve, or vice versa from a tibial intraneural cyst to the peroneal nerve. ⋯ This study provides direct in vivo proof of the nature of sciatic cross-over theorized by critical review of MRIs and/or experimental dye injections done in cadavers. This study is important in clarifying the potential paths of propagation of intraneural cysts at points of major bifurcation.
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Acta neurochirurgica · Dec 2008
Differences in cell death between high and low energy brain injury in adult rats.
Traumatic brain damage is dependent on energy transfer to the brain at impact. Different injury mechanisms may cause different types of brain injury. It is, however, unknown if the relative distribution between apoptotic cell-death and necrotic cell- death in different populations of brain cells varies depending on energy transfer. ⋯ Increasing energy transfer in a model for brain contusion demonstrated qualitative and quantitative changes in the pattern of cell death. This complexity must be considered when evaluating brain-protection as treatment results may vary depending on which cellular population and which mechanism of cell death is treated under the exact experimental and clinical conditions.