Acta neurochirurgica
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Acta neurochirurgica · Apr 2013
Sodium fluorescein-guided resection under the YELLOW 560 nm surgical microscope filter in malignant brain tumor surgery--a feasibility study.
In glioma surgery, the extent of resection (EOR) is one important predictor of progression-free survival. In 2006, fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) was shown to improve the EOR in malignant gliomas. However, the use of 5-ALA is complex and causes certain side effects. Sodium fluorescein (FL) is a fluorescent dye that is used for angiography in ophthalmic surgery. FL accumulates in areas of the disturbed blood-brain barrier and can be visualized under a 560-nm wavelength fluorescent light source (YELLOW 560 nm, Carl Zeiss Meditec, Oberkochen, Germany). Here, we present the first experiences with low-dose FL and YELLOW 560 nm in 35 patients with malignant brain tumors. ⋯ The use of FL for the resection of brain tumors is safe and feasible. Presumably, the visualization of the tumor margin depends on the histopathology and on the pre-treatment status. A randomized evaluation of FL under the YELLOW 560 nm filter is planned to prospectively analyze the extent of resection in patients with malignant brain tumors.
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Acta neurochirurgica · Apr 2013
Health-related quality of life at median 12 months after aneurysmal subarachnoid hemorrhage, measured with EuroQoL-5D.
A measurement of quality of life (QoL) should cover the important aspects of daily life and be easy to perform. Ease of performance is especially important for patients with spontaneous subarachnoid haemorrhage (SAH), since fatigue and cognitive disabilities are known sequeles. EuroQoL (EQ-5D) is a preference-based instrument measuring QoL, based on self-reported health status in five dimensions: Mobility, Self-Care, Usual Activities, Pain/Discomfort and Anxiety/Depression. In the present study EuroQoL was used in patients with aneurysmal SAH (aSAH) in comparison with a Swedish reference population. We also determined the extent to which demographic characteristics and clinical parameters predicted outcome. ⋯ The nature of the sequeles after SAH depends on severity of disease, gender and treatment method. These factors should be more emphasised in planning rehabilitation.
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Acta neurochirurgica · Apr 2013
Experimental high-altitude intracerebral hemorrhage in minipigs: histology, behavior, and intracranial pressure in a double-injection model.
Specific pathophysiological mechanism in intracerebral hemorrhage (ICH) at high altitude is unclear, and at present, there is no relevant and suitable animal model. ⋯ The injury resulting from ICH at high altitude was more severe than that in the plain group. This model was able to produce controllable and reproducible hematomas and visible neurological deficits, which may be useful for future studies of the pathophysiology and functional rehabilitation of high-altitude ICH disease.
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Acta neurochirurgica · Mar 2013
Comparative StudyHow I do it--pineal surgery: supracerebellar infratentorial versus occipital transtentorial.
Resection of a pineal tumour requires fastidious pre-operative planning to select the optimal surgical approach and maximise resection while minimising morbidity. ⋯ Specific considerations include patient-specific anatomy, extent and relationships of the tumour, and the techniques likely to be employed during resection. The supracerebellar infratentorial approach provides a direct corridor to pineal tumours caudal to the deep veins; for tumours invaginating the tectal plate in a caudal direction the occipital transtentorial provides a better view.
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Acta neurochirurgica · Mar 2013
Application of low-field intraoperative magnetic resonance imaging in transsphenoidal surgery for pituitary adenomas: technical points to improve the visibility of the tumor resection margin.
Intraoperative magnetic resonance imaging (iMRI) is proven to be advantageous in transsphenoidal surgery (TSS) for pituitary adenomas. We evaluated the efficacy of low-field iMRI. Also, we described several techniques to enhance the visibility of the tumor resection margin. ⋯ iMRI maximizes the extent of resection and minimizes the possibility of unexpected tumor remnants in TSS for pituitary adenomas. It is essential to reduce imaging artifacts and enhance the visibility of the tumor resection margin during the use of low-field iMRI.