Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Mar 2015
OCT measurements of optic nerve head changes in idiopathic intracranial hypertension.
Severity of papilledema and vision loss constitute a basis for therapeutic intervention in idiopathic intracranial hypertension (IIH), but both are often subjective and insensitive in guiding clinical management. The aim of this study was to identify reliable and sensitive measurements of optic nerve head (ONH) and macula, to provide objective guidance for prognostic evaluation and treatment in IIH. We analyzed potential of spectral domain optical coherence tomography (SD-OCT), to measure neuro-retinal rim thickness and area, optic cup-to-disc ratio (C/D) and cup volume of ONH which have not previously been reported in IIH. In parallel, thickness of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell layer (GCL) together with inner plexiform layer (IPL) (GCL-IPL) were examined. ⋯ SD-OCT allows detection of ONH changes even in subtle IIH without papilledema and has potential for routine use in IIH.
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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
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.
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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.