Journal of neurosurgery
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Some of Fedor Krause's contributions to operative technique are reviewed and portrayed as fundamental steps in the progress of neurological surgery. The approaches he devised, the "Krause operations," are exposure of the trigeminal ganglion and root, of the cerebellopontine angle, and of the pituitary (transfrontal) and the pineal (supracerebellar) regions. This review recalls the significance of the aggregate body of Krause's work, which has not been fully appreciated except by his compatriots.
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Journal of neurosurgery · Jun 1992
Comment Letter Case ReportsThecoperitoneal shunt for syringomyelia.
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Journal of neurosurgery · Jun 1992
Apnea testing for the determination of brain death: a modified protocol. Technical note.
The absence of spontaneous respirations at a PaCO2 of 60 mm Hg or above has traditionally been accepted as the respiratory criteria for the determination of brain death. The testing of patients for the presence or absence of apnea has been complicated because the rate of PaCO2 elevation may vary substantially from patient to patient, and a nonlinear relationship exists between the rate of PaCO2 increase and the duration of apnea. In an attempt to refine the apnea test and to further elucidate the physiology of hypercapnia in humans, 11 patients who met all but the respiratory criteria for brain death were evaluated using a modification of a previously utilized apnea testing protocol. ⋯ The mean rate of PaCO2 increase was 5.1 +/- 1.4 mm Hg/min in Group I and 6.7 +/- 3.1 mm Hg/min in Group II. No problems with cardiovascular instability or hypoxia were encountered during testing in this series. This refinement of the apnea test allows for a streamlined and safe approach to brain death detection.
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Journal of neurosurgery · Jun 1992
Patient-interactive, computer-controlled neurological stimulation system: clinical efficacy in spinal cord stimulator adjustment.
Over the past 20 years, continuing technical advances have rendered spinal cord stimulation an easily implemented low-morbidity technique for the management of chronic intractable pain in properly selected patients. Percutaneous methods for the insertion of arrays of multiple epidural electrodes, which are driven by noninvasively programmable "multichannel" implanted devices, have been among the most important of these technical improvements. The same implanted electronics may be used with peripheral nerve or intracerebral electrodes. ⋯ The time required by the average patient working with this system to adjust the stimulator is comparable to or less than the time required by the same patient working with a physician's assistant. Psychophysical data collected by the system may be correlated with clinical observations. Ongoing development will permit delivery of novel pulse sequences and protocols to assess the mechanisms by which stimulation affords relief from pain.