Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Feb 2015
Comparative StudyComparison of seeding methods for visualization of the corticospinal tracts using single tensor tractography.
To compare five different seeding methods to delineate hand, foot, and lip components of the corticospinal tract (CST) using single tensor tractography. ⋯ Whole brain seeding and then selecting the tracts that pass through two anatomically relevant ROIs can delineate more plausible hand and lip motor tracts than seeding from a single ROI. Foot motor tracts can be successfully delineated regardless of the seeding method used.
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Clin Neurol Neurosurg · Feb 2015
Preoperative MRI in neurovascular compression syndromes and its role for microsurgical considerations.
Neurovascular compression (NVC) in the posterior fossa is characterized by complex, three-dimensional (3D) neurovascular relationships at the root entry zones (REZ) and other parts of cranial nerves, resulting in syndromes such as trigeminal neuralgia (TN), hemifacial spasm, vertigo and glossopharyngeal neuralgia. Microvascular decompression (MVD) requires microsurgical experience and 3D orientation within the cisternal spaces to achieve adequate clinical results. The vascular structures in anatomical relation to the trigeminal nerve root at the lateral pontine aspect of the brainstem should be examined and maximally decompressed to minimize the risk of recurrent TN. Indication was traditionally based on clinical decisions, only. New MR techniques have become available, and their chances and potential impact should be evaluated in this study. ⋯ We show that high resolution MR images provide reliable and detailed information on corresponding intraoperative anatomy. Especially in unusual cases, the application of such MR techniques and preoperative evaluation may contribute to indication, planning, and also for teaching purposes.
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Clin Neurol Neurosurg · Feb 2015
Thoracic lateral extracavitary corpectomy for anterior column reconstruction with expandable and static titanium cages: clinical outcomes and surgical considerations in a consecutive case series.
Many surgical interventions have emerged as effective means of restoring mechanical stability of the anterior column of the spine. The lateral extracavitary approach (LECA) allows for broad visualization and circumferential reconstruction of the spinal column. However, early reports demonstrated significant complication rates, protracted operative times, and prolonged hospitalizations. More recent reports have highlighted concerns for subsidence, particularly with expandable cages. Our work seeks to describe a single-surgeon consecutive series of patients undergoing LECA for thoracic corpectomy. Specifically, the objective was to explore the surgical considerations, clinical and radiographic outcomes, and complication profile of this approach. ⋯ The LECA approach for anterior column reconstruction with static or expandable cages is an important surgical consideration with favorable surgical parameters and complication rates. Further, use of expandable cages may allow for reconstruction over a larger segment without increased risk of subsidence.
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Clin Neurol Neurosurg · Feb 2015
Clinical TrialKinetics features changes before and after intra-articular hyaluronic acid injections in patients with knee osteoarthritis.
To examine the kinetic features in patients with knee osteoarthritis (OA) after intra-articular hyaluronic acid (IAHA) injections in different time periods. ⋯ This study revealed that IAHA injections can provide significant pain relief and improvement in activity of daily living function for patients with knee OA. However, the reduction in pain and the increase in knee adduction moment may last up to 6 months. This may cause excessive loading on the knee joints, which may further accelerate the rate of knee degeneration. As a result, longer study time is needed to determine whether the observed kinetic findings in this study are associated with detrimental outcomes on the knee joints.
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Clin Neurol Neurosurg · Feb 2015
Endoscope-assisted keyhole surgery via an eyebrow incision for removal of large meningiomas of the anterior and middle cranial fossa.
Conventional open surgery of large meningiomas has proven to be challenging even in experienced hands. Intense retraction and dissection around neurovascular structures increase morbidity and mortality. In the present study, we retrospectively analyzed the surgical technique, and outcome in 40 patients with large anterior cranial fossa meningiomas extending to the middle fossa. All patients were approached via a supraorbital mini craniotomy. ⋯ With the appropriate keyhole approach as a refinement of the classic keyhole craniotomy to a smaller key"burr"hole, and with use of modern and new designed equipment, it is possible to perform complete resection of large anterior and middle fossa meningiomas with the same safety, efficiency and with less complication rates as described in the literature for large meningiomas even performed with classic keyhole craniotomies.