Journal of neurosurgery
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Journal of neurosurgery · Oct 2002
Case Reports Clinical TrialMagnetoencephalography-directed surgery in patients with neocortical epilepsy.
Magnetoencephalography (MEG) and magnetic source (MS) imaging are techniques that have been increasingly used for preoperative localization of epileptic foci and areas of eloquent cortex. The use of MEG examinations must be carefully balanced against the high cost and technological investments required to perform these studies, particularly when less expensive alternative localization methods are available. To help elucidate the value of MEG, the authors have critically reviewed their experience with whole-head MEG in the case management of patients undergoing epilepsy surgery. ⋯ Magnetic source imaging can provide unique localization information that is not available when other noninvasive methods are used. Magnetic source imaging appears most useful for cases of neocortical epilepsy. In particular, when an MS imaging study revealed six or more interictal spikes that were densely clustered in a single anatomical location, the MS image was highly correlated with the zone of seizure origin identified by ECoG. In these cases the MS imaging data may be useful to guide placement of intracranial electrodes.
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Journal of neurosurgery · Oct 2002
Randomized Controlled Trial Clinical TrialTreatment of chronic pain by using intrathecal drug therapy compared with conventional pain therapies: a cost-effectiveness analysis.
The object of this study was to compare the cost-effectiveness of intrathecal drug therapy (IDT) with that of conventional pain therapy (CPT) in patients suffering from chronic low back pain caused by failed back syndrome. In this study, the authors tabulated actual costs, in Canadian dollars, in a consecutive series of patients undergoing IDT within the Canadian health care system and have compared them with costs in a control group in the same environment. The influence of these treatments on the quality of life (QOL) was also analyzed. ⋯ In patients who respond to this treatment, IDT is cost effective in the long term despite high initial costs of implantable devices.
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Journal of neurosurgery · Oct 2002
Histopathological validation of a three-dimensional magnetic resonance spectroscopy index as a predictor of tumor presence.
Data obtained preoperatively from three-dimensional (3D)/proton magnetic resonance (MR) spectroscopy were compared with the results of histopathological assays of tissue biopsies obtained during surgery to verify the sensitivity and specificity of a choline-containing compound-N-acetylaspartate index (CNI) used to distinguish tumor from nontumorous tissue within T2-hyperintense and contrast-enhancing lesions of patients with untreated gliomas. The information gleaned from the biopsy correlation study was used to test the hypothesis that there is metabolically active tumor in nonenhancing regions of the T2-hyperintense lesion that can be detected using MR spectroscopy. ⋯ Biopsy samples containing tumor were distinguished from those containing a mixture of normal, edematous, gliotic, and necrotic tissue with 90% sensitivity and 86% specificity by using a CNI threshold of 2.5. The CNIs of nontumorous specimens were significantly different from those of biopsy specimens containing Grade II (p < 0.03), Grade III (p < 0.005), and Grade IV (p < 0.01) tumors. On average, one third to one half of the T2-hyperintense lesion outside the contrast-enhancing lesion contained CNI greater than 2.5.
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Journal of neurosurgery · Oct 2002
Comparative StudyComparison of different infratentorial-supracerebellar approaches to the posterior and middle incisural space: a cadaveric study.
The purpose of this investigation was to describe and compare through cadaveric dissection the microsurgical exposure afforded by the median, paramedian, and extreme-lateral infratentorial-supracerebellar approaches to the posterior and middle incisural space. ⋯ The infratentorial-supracerebellar approaches allow safe circumferential exposure of the posterior and middle incisural space. Choosing among different variants allows the surgeon to reach selected areas, with the midline variant being best for exposure of the posterior incisural space, and the paramedian and extreme-lateral variants being best for reaching the posterior and the anterior part of the middle incisural space, respectively. The more lateral the approach, the more anterior and multiangled the exposure gained. Complete, constant exposure and retraction of the dural sinuses improves the exposure. Accurate knowledge of the regional anatomy is mandatory.
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Journal of neurosurgery · Oct 2002
Case ReportsPercutaneous transpedicular vertebroplasty with calcium phosphate cement in the treatment of osteoporotic vertebral compression and burst fractures.
Osteoporotic vertebral fractures occasionally lead to late-onset collapse, kyphosis, persistent back pain, and disability. The authors describe a series of patients in whom they performed percutaneous vertebroplasty by using calcium phosphate cement (CPC) to obtain early pain relief and improve the integrity of the osteoporotic vertebral body (VB). ⋯ Percutaneous transpedicular CPC-assisted vertebroplasty is a minimally invasive procedure that provides early relief of pain and prevents vertebral collapse and pseudarthrosis in patients with osteoporotic vertebral fracture.