Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · May 2007
Randomized Controlled Trial Comparative StudyAwake craniotomy versus surgery under general anesthesia for resection of intrinsic lesions of eloquent cortex--a prospective randomised study.
Complete removal of a brain tumor without inflicting neurological deficits is a desirable end result in neurosurgical practice. Currently no prospective randomized surgical series in the literature exists comparing tumor resection under general versus local anesthesia awake surgery may achieve more aggressive tumor resection and minimize postoperative neurological morbidity. ⋯ The mean operative time, blood loss was found to be was found to be less in GA group patients than in awake group. Better tumor cytoreduction, neurological improvement was seen in GA group (motor improvement in 35.7%, speech improvement in 62.5%) than in awake group patients (motor improvement in 18.7%, speech improvement in 14.3%).
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Clin Neurol Neurosurg · May 2007
Case ReportsMotor neuron disease-like syndrome secondary to trapped fourth ventricle and obstruction of cerebrospinal fluid pathway.
The trapped fourth ventricle is caused by occlusion of outlets of fourth ventricle, including cerebral aqueduct and foramina of Luschka and Magendie. It is an uncommon entity that mainly occurs in children with hydrocephalus after successful shunting of lateral ventricles. The most common etiologies of obstruction to outflow of the fourth ventricle are infection and hemorrhage. ⋯ After surgical decompression and lysis of adhesion of posterior fossa, neurological deficits well recovered. The pathogenesis of hand muscle atrophy is secondary to cervical cord edema caused by trapped fourth ventricle and obstruction of cerebrospinal fluid (CSF) pathway. Furthermore, the anterior horn cells and lateral corticospinal tract are located in the highly vulnerable region of spinal cord, either possibly due to venous engorgement or arterial insufficiency.
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Clin Neurol Neurosurg · May 2007
Case ReportsPrefrontal cognitive dysfunction following brainstem lesion.
Prefrontal cortex (PFC) dysfunction can lead to impairment in planning and behavioral inhibition, as well as personality changes. As ascending monoaminergic brainstem systems modulate PFC functioning, it is possible that lesions in the brainstem lead to symptoms similar to prefrontal dysfunction. ⋯ Interestingly, the cognitive symptoms improved after treatment with methylphenidate, which is a drug that modules catecholaminergic neurotransmission, thereby supporting this hypothesis. This is a unique case of PFC dysfunction that may be related to post-operative lesion of the catecholaminergic nuclei in the brainstem.