Acta neurochirurgica
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Acta neurochirurgica · Jan 2007
Haemodynamic patterns in children with posttraumatic diffuse brain swelling. A preliminary study in 6 cases with neuroradiological features consistent with diffuse axonal injury.
In the present report we describe the cerebral haemodynamics and the neuroradiological findings observed in six consecutive children, three males and three females aged 4-15.6 yrs (mean age 8.95) displaying a neuroradiological pattern consistent with diffuse axonal injury (DAI) along with slit ventricles. ⋯ Intracranial hypertension can be elevated in pediatric posttraumatic hyperflow syndromes associated with DAI. The observation of the time course of the parameters studied allowed us to modify the pharmacological treatment and/or perform surgical decompression (external cerebrospinal fluid (CSF) drainage in five cases; decompressive craniectomy in one case). Compartmental hyperflow TCD pattern was evident in only one patient. Although the limited number of pa tients in our series does not allow definite conclusions, we strongly believe that TCD, with ICP and CEO(2) monitoring, are useful tools in planning surgical strategy in children with neuroradiological signs of DAI.
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Acta neurochirurgica · Jan 2007
Six months post-operative clinical and 24 hour post-operative MRI examinations after nucleoplasty with radiofrequency energy.
Minimally invasive techniques are gaining popularity for the treatment of discogenic low-back pain. Nucleoplasty is a relatively new procedure that uses radiofrequency energy to disintegrate and evacuate the disc material. The purpose of this study is to examine the early post-operative radiological changes after lumbar nucleoplasty and to assess the short-term effects of this procedure on discogenic lower back pain and leg pain. ⋯ Although, nucleoplasty appeared to be a safe minimally invasive procedure, the value of this new technique for the treatment of discogenic low-back pain remains as yet unproven. Further randomised placebo-controlled studies with longer follow-up are needed to elucidate the effects of nucleoplasty on discogenic low back and leg pain.
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Acta neurochirurgica · Jan 2007
Decompressive hemicraniectomy in patients with subarachnoid hemorrhage and intractable intracranial hypertension.
To evaluate the outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) developing intractable intracranial hypertension and treated by decompressive hemicraniectomy (DHC). ⋯ In more than half of the patients with intractable intracranial hypertension after aSAH a good functional outcome could be achieved after DHC. Patients with progressive brain edema without radiological signs of infarction and those with hematoma may benefit most. The indication for DHC should be set restrictively if secondary infarcts are manifest.
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Acta neurochirurgica · Jan 2007
Functional neuronavigation combined with intra-operative 3D ultrasound: initial experiences during surgical resections close to eloquent brain areas and future directions in automatic brain shift compensation of preoperative data.
The aims of this study were: 1) To develop protocols for, integration and assessment of the usefulness of high quality fMRI (functional magnetic resonance imaging) and DTI (diffusion tensor imaging) data in an ultrasound-based neuronavigation system. 2) To develop and demonstrate a co-registration method for automatic brain-shift correction of pre-operative MR data using intra-operative 3D ultrasound. ⋯ In the present study we have demonstrated how both fMRI and DTI data can be acquired and integrated into a neuronavigation system for improved surgical planning and guidance. The surgeons reported that the integration of fMRI and DTI data in the navigation system represented valuable additional information presented in a user-friendly way and functional neuronavigation is now in routine use at our hospital. Furthermore, the present study showed that automatic ultrasound-based updates of important pre-operative MRI data are feasible and hence can be used to compensate for brain shift.
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Acta neurochirurgica · Jan 2007
Chiari I malformation associated with atlanto-axial dislocation: focussing on the anterior cervico-medullary compression.
Chiari I malformation with atlantoaxial dislocation may cause both posterior and anterior cervicomedullary compression. We studied the clinicoradiological features and surgical outcome in patients having Chiari I malformation with atlantoaxial dislocation. ⋯ Patients with Chiari I malformation should be investigated for the presence of atlanto-axial dislocation. In case atlantoaxial dislocation coexists, priority must be given to relieving anterior cervicomedullary compression.