Journal of neurosurgery
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Near infrared transmission spectroscopy of the human cerebrum may allow noninvasive evaluation of cerebral hemoglobin saturation in humans. The emerging spectroscopy configuration for this application is a side-by-side source-receiver construct. ⋯ In all five, simultaneous two-channel infrared transmission spectroscopy over the ipsilateral hemisphere documented tracer bolus transit with a signal-to-noise ratio greater than 100:1. In addition, the two channels could be configured to achieve depth resolution of the collected spectra.
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Brachial plexus palsy due to traction injury, especially spinal nerve-root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. Nerve transfer is the only possibility for repair in cases of spinal nerve-root avulsion. ⋯ The most favorable results, with an 83.8% overall rate of useful functional recovery, were obtained in patients with upper brachial plexus palsy in which regional donor nerves, such as the medial pectoral, thoracodorsal, long thoracic, and subscapular nerves, had been used. The overall rates of recovery for the spinal accessory and upper intercostal nerves were 64.3% and 55.5%, respectively, which are significantly lower. The authors evaluate the results of nerve transfer and analyze different donor nerves as factors influencing the prognosis of surgical repair.
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Journal of neurosurgery · Feb 1992
Continuous monitoring of jugular venous oxygen saturation in head-injured patients.
The continuous measurement of jugular venous oxygen saturation (SjvO2) with a fiberoptic catheter is evaluated as a method of detecting cerebral ischemia after head injury. Forty-five patients admitted to the hospital in coma after severe head injury had continuous and simultaneous monitoring of SjvO2, intracranial pressure, arterial oxygen saturation, and end-tidal CO2. Cerebral blood flow, cerebral metabolic rates of oxygen and lactate, arterial and jugular venous blood gas levels, and hemoglobin concentration were measured every 8 hours for 1 to 11 days. ⋯ In 20 patients the desaturation value was confirmed by the co-oximeter. There were 33 episodes of desaturation in these 20 patients, due to the following causes: intracranial hypertension in 12 episodes, hypocarbia in 10, arterial hypoxia in six, combinations of the above in three, systemic hypotension in one, and cerebral vasospasm in one. The incidence of jugular venous oxygen desaturations found in this study suggests that continuous monitoring of SjvO2 may be of clinical value in patients with head injury.
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Journal of neurosurgery · Feb 1992
Evoked potentials from direct cerebellar stimulation for monitoring of the rodent spinal cord.
Although the assessment of spinal cord function by electrophysiological techniques has become important in both clinical and research environments, current monitoring methods do not completely evaluate all tracts in the spinal cord. Somatosensory and motor evoked potentials primarily reflect dorsal column and pyramidal tract integrity, respectively, but do not directly assess the status of the ventral funiculus. The present study was undertaken to evaluate the use of evoked potentials, elicited by direct cerebellar stimulation, in monitoring the ventral component of the rodent spinal cord. ⋯ Unilateral cerebellar stimulation resulted in bilateral sciatic nerve and gastrocnemius muscle responses; there were no significant differences (p greater than 0.05) in the thresholds, amplitudes, or latencies of these responses elicited by right- versus left-sided stimulation. Recordings performed following creation of selective lesions of the cervical cord indicated that the thoracic response was carried primarily in the ventral funiculus while the sciatic and gastrocnemius responses were mediated through the dorsal half of the spinal cord. It is concluded that the posterior fossa evoked potential has research value as a method of monitoring pathways within the ventral spinal cord of the rat, and should be useful in the study of spinal cord injury.
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Journal of neurosurgery · Feb 1992
Biography Historical ArticlePercivall Pott: an 18th century neurosurgeon.
This paper examines neurosurgery in the 18th century and suggests that the origins of the specialty can be recognized at the time when surgeons began to use the neurological status of the patient as a guide for surgical intervention. Percivall Pott (1714-1788) was one of the leading surgeons in London in the 18th century. ⋯ The recognition and significance of the lucid interval was described and understood as a neurosurgical sign in the 18th century. Because of Pott's pre-eminence in the surgery of his time through his writings and lectures, he should be considered one of the founders of neurosurgery as a separate surgical discipline.