Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Mar 2015
Brain metabolism assessed via proton magnetic resonance spectroscopy in patients with amnestic or vascular mild cognitive impairment.
To address the possible role of brain regional metabolic differences between different types of mild cognitive impairment (MCI). ⋯ This study indicated that there are differences in metabolism related to brain regions between A-MCI and V-MCI, thus it may be concluded that 1H MRS may be a useful tool to differentiate A-MCI and V-MCI.
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Clin Neurol Neurosurg · Mar 2015
Lateral transzygomatic middle fossa approach and its extensions: surgical technique and 3D anatomy.
Various approaches to lesions involving the middle fossa and cavernous sinus (CS), with and without posterior fossa extension have been described. In the present study, we describe the surgical technique for the extradural lateral tranzygomatic middle fossa approach and its extensions, highlight relevant 3D anatomy. ⋯ The present study illustrates 3D anatomical relationships of the lateral transzygomatic middle fossa approach with its extensions. This approach allows wide access to different topographic areas (clinoidal region and clinoidal ICA, the entire CS, and the posterior fossa from the interpeduncular fossa to the facial nerve) via a lateral trajectory. Precise knowledge of technique and anatomy is necessary to properly execute this approach.
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Clin Neurol Neurosurg · Mar 2015
Intraoperative neurophysiological monitoring for intradural extramedullary tumors: why not?
While intraoperative neurophysiological monitoring (IOM) for intramedullary tumors has become a standard in neurosurgical practice, IOM for intradural extramedullary tumors (IDEMs) is still under debate. The aim of this study is to evaluate the role of IOM during surgery for IDEMs. ⋯ In our series significant IOM changes occurred in 5 out of 68 patients with IDEMs (7.35%), and it is conceivable that the modification of the surgical strategy - induced by IOM - prevented or mitigated neurological injury in these cases. Vice versa, in 63 patients (92.65%) IOM invariably predicted a good neurological outcome. Furthermore this technique allowed a safer tumor removal in IDEMs placed in difficult locations as cranio-vertebral junction or in antero/antero-lateral position (where rotation of spinal cord can be monitored) and even in case of tumor adherent to the spinal cord without a clear cleavage plane.
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Clin Neurol Neurosurg · Mar 2015
Anterior stabilization for unstable traumatic thoracolumbar spine burst fractures.
Traumatic injuries to the thoracolumbar spine result in a high incidence of unstable fractures. The goal of the surgical management is to achieve an adequate decompression and stabilization. We have analyzed operative and postoperative features of anterior surgical approaches. ⋯ Based on our findings, anterior surgical approach appears to be a safe and effective technique for managing traumatic thoracic and lumbar unstable burst fractures. This is also evident that anterior decompression and stabilization achieves a significant correction of kyphotic deformity with a lower risk of neurological deterioration and pseudoarthrosis.