Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
Case ReportsAvoidance of electrode related MRI artifact during staged deep brain stimulator implantation.
Centers implanting deep brain stimulator (DBS) electrodes on different days often protect the first electrode tip with a protective cap, tunnel it under the scalp, and connect it to the generator at a later procedure. If magnetic resonance imaging (MRI) is used for planning during the second implantation, MRI artifacts from the protective cap could potentially corrupt the stereotactic coordinates. The importance of this problem may increase if emerging MRI safety data lead to more frequent use of MRI for these purposes. ⋯ A silastic sleeve provides adequate protection of the DBS electrode during staged implantation and avoids the MRI artifact associated with protective caps with screws.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
CSF fistulas after transsphenoidal pituitary surgery--a solved problem?
Transsphenoidal surgery has been the gold standard for intra- and suprasellar lesions as well as some extrasellar pathologies for more than 40 years. This approach, with proper surgical expertise, is very safe with a low morbidity and mortality rate. However, as with every surgical treatment, complications can occur and may result in serious consequences for the patient. The goal of this article is to focus on cerebrospinal fluid (CSF) fistulas after transsphenoidal surgery and discuss possible risk factors and treatment options, including less common procedures in persistent CSF fistulas. ⋯ CSF fistulas continue to present a problem after transsphenoidal surgery and require sophisticated technical measures to treat this complication. Failure after repair can occur and necessitates more intense treatment modalities. The usage of the transsphenoidal approach in other skull base lesions leads to higher rates of CSF fistulas and subsequently higher frequency of meningitis.
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J Neurol Surg A Cent Eur Neurosurg · Aug 2012
Review Historical ArticleTraumatic brain injuries in the ancient Egypt: insights from the Edwin Smith Papyrus.
Traumatic brain injury (TBI) is probably as old as human beings. The Edwin Smith Papyrus is the first treatise describing the treatment of patients with TBI and allows insights into the medical examination and treatment of head-injured patients in ancient Egypt. ⋯ The Edwin Smith Papyrus reveals astonishing observation skill when considering the methods and limits of ancient times. These physicians were able to recognize many symptoms of TBI and assign them a prognostic value.
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J Neurol Surg A Cent Eur Neurosurg · Aug 2012
Randomized Controlled TrialEarly survival of comatose patients after severe traumatic brain injury with the dual cannabinoid CB1/CB2 receptor agonist KN38-7271: a randomized, double-blind, placebo-controlled phase II trial.
BACKGROUND AND STUDY OBJECT: Despite many drug trials, no substance has yet been identified that improves the outcome of severe head injury. The dual cannabinoid CB1/CB2 receptor agonist KN38-7271 mediates potent neuroprotection in animal models. We describe here the first randomized, double-blind, prospective, placebo-controlled clinical phase IIa proof-of-concept trial to investigate the safety, pharmacokinetics, and potential efficacy of a cannabinoid receptor agonist in humans. ⋯ KN38-7271 appeared beneficial in the acute early phase of the comatose patient after a head injury. Its use was safe and well tolerated by patients. These results may provide the basis for further phase II/III trials in larger study populations.
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J Neurol Surg A Cent Eur Neurosurg · May 2012
Case ReportsA reminder for a very rare entity: massive tongue swelling after posterior fossa surgery.
The purpose of this study is to report a case of presumably neurogenic macroglossia that occurred after surgical trapping of a vertebral artery (VA)-posteroinferior cerebellar artery aneurysm, and to analyze its potential pathogenesis. ⋯ Macroglossia is a rare complication following neurosurgical procedures with very few cases reported so far. It has been attributed to the sitting position and venous flow congestion. We illustrate a case of macroglossia, which occurred following surgery in the prone position. Its etiology remains speculative, but a neurogenic explanation seems most plausible.