Journal of neurosurgery
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Journal of neurosurgery · Jan 1999
Randomized Controlled Trial Clinical TrialThe role of bupivacaine in early postoperative pain control after lumbar decompression.
The authors studied the effect of immediate postoperative administration of bupivacaine in patients who underwent a lumbar decompressive procedure. ⋯ Results of subgroup analysis suggested strongly that perioperative administration of methylprednisolone in a sustained-release preparation was associated with a reduction in postoperative pain (p<0.05).
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Journal of neurosurgery · Jan 1999
Interhemispheric supratentorial intracranial pressure gradients in head-injured patients: are they clinically important?
It is generally accepted that the intracranial compartment behaves as a unicameral space in which intracranial pressure (ICP) is uniformly distributed. However, this concept has been challenged many times. Although there is general agreement on the existence of craniospinal and suprainfratentorial gradients, the existence of interhemispheric gradients is still a matter of debate. The object of this study was to reexamine the issue of interhemispheric supratentorial ICP gradients in patients with head injuries and the clinical significance of these gradients in their management. ⋯ In many patients with focal lesions, clinically important interhemispheric ICP gradients exist. In this subset, transient gradients that disappear with time are frequently observed and may indicate an increase in the size of the lesion. The clinical relevance of such gradients is discussed and guidelines for adequately monitoring ICP are suggested to optimize head injury management and to avoid suboptimal or even harmful care in patients with mass lesions.
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Journal of neurosurgery · Jan 1999
Accuracy of true frameless stereotaxy: in vivo measurement and laboratory phantom studies. Technical note.
The authors present the results of accuracy measurements, obtained in both laboratory phantom studies and an in vivo assessment, for a technique of frameless stereotaxy. An instrument holder was developed to facilitate stereotactic guidance and enable introduction of frameless methods to traditional frame-based procedures. The accuracy of frameless stereotaxy was assessed for images acquired using 0.5-tesla or 1.5-tesla magnetic resonance (MR) imaging or 2-mm axial, 3-mm axial, or 3-mm helical computerized tomography (CT) scanning. ⋯ The mean in vivo linear error of frameless stereotactic biopsy sampling was 2.3 mm (SD 1.9 mm). The mean in vivo Euclidean error was 4.8 mm (SD 2 mm). The implications of these accuracy measurements and of error in stereotaxy are discussed.
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Journal of neurosurgery · Jan 1999
Risk of injury to cranial nerves after gamma knife radiosurgery for skull base meningiomas: experience in 88 patients.
In this study the authors sought to determine the neurological risks and potential clinical benefits of gamma knife radiosurgery for skull base meningiomas. ⋯ Gamma knife radiosurgery appeared to be an effective method to control the growth of most skull base meningiomas in this intermediate-term study. The risk of trigeminal neuropathy seemed to be associated with doses of more than 19 Gy, and the optic apparatus appeared to tolerate doses greater than 10 Gy. Considering the risks to cranial nerves associated with open surgery for comparable tumors, the authors believe that gamma knife radiosurgery is a useful method for the management of properly selected recurrent, residual, or newly diagnosed skull base meningiomas.