Journal of neurosurgery
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Journal of neurosurgery · Oct 2000
Clinical TrialIntraoperative endovascular treatment as an adjunct to microsurgical clipping of paraclinoid aneurysms.
The endovascular procedure can provide proximal control, suction decompression, and prompt intraoperative angiography during microsurgical clipping of aneurysms of the paraclinoid segment of the internal carotid artery (ICA). The authors assess the safety and feasibility of this method in 24 consecutive cases. ⋯ The endovascular method allows safe and reliable proximal control, suction decompression, and intraoperative angiography in microsurgical treatment of large paraclinoid aneurysms.
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The pericallosal arterial complex supplies the callosal and pericallosal regions, as well as the anterior two thirds of the medial and superomedial aspects of both hemispheres. It is composed of the pericallosal artery (that is, the segment of the anterior cerebral artery located distal to the anterior communicating artery [ACoA]) and the median callosal artery (or third pericallosal artery), which originates from the ACoA. This system was studied in 46 specimens (23 human cadaver heads) injected with colored latex. ⋯ The authors propose a logical classification of the different variations in the pericallosal arterial complex based on embryological development. This complex can be considered a hemodynamic solution to an abnormal regression of one of its parts, which is balanced by the development of supplemental channels from other parts.
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The occurrence of intracranial ependymomas in children is relatively infrequent, and their prognostic factors are still controversial, especially regarding histological composition. ⋯ This study and analysis of the literature further highlight that total tumor removal is the treatment of choice for ependymomas in children. Postoperative measurement of residual tumor is required, especially because a subgroup of patients might be treated by surgery alone. Median infratentorial ependymomas have to be distinguished from the lateral type. Appropriate and reproducible histological parameters and Ki-67 LI are of interest as predictors of outcome.
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Journal of neurosurgery · Oct 2000
Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases.
The goal of this study was to investigate the protective effects of long-term (3-14 days) mild hypothermia therapy (33-35 degrees C) on outcome in 87 patients with severe traumatic brain injury (TBI) (Glasgow Coma Scale score < or = 8). ⋯ The data produced by this study demonstrate that long-term mild hypothermia therapy significantly improves outcomes in patients with severe TBI.
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Journal of neurosurgery · Oct 2000
Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery.
Electromyography (EMG) monitoring is expected to reduce the incidence of motor cranial nerve deficits in cerebellopontine angle surgery. The aim of this study was to provide a detailed analysis of intraoperative EMG phenomena with respect to their surgical significance. ⋯ It could be demonstrated that the occurrence of A trains is a highly reliable predictor for postoperative facial palsy. Although some degree of functional worsening is to be expected postoperatively, there is a good chance of avoiding major deficits by warning the surgeon early. Continuous EMG monitoring is superior to electrical nerve stimulation or acoustic loudspeaker monitoring alone. The detailed analysis of EMG-waveform characteristics is able to provide more accurate warning criteria during surgery.