Journal of neurosurgery
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Journal of neurosurgery · Jun 2003
Case Reports Clinical TrialRegional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage.
The goal of this study was to evaluate regional cerebral blood flow (rCBF) monitoring, performed using thermal-diffusion (TD) flowmetry, as a novel means for the bedside diagnosis of symptomatic vasospasm. ⋯ Thermal-diffusion flowmetry represents a promising method for the bedside monitoring of patients with SAH to detect symptomatic vasospasm. This is of major clinical interest for patients with high-grade SAH, who often cannot be assessed neurologically.
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Journal of neurosurgery · Jun 2003
Randomized Controlled Trial Clinical TrialEffect of the local anesthetic agent bupivacaine prior to application of the skull-pin holder for craniotomies.
The authors conducted a double-blind prospective randomized study to determine whether infiltration of Mayfield skull-pin sites with 0.5% bupivacaine, compared with placebo, would prevent hemodynamic stimulation, thus allowing for a reduction in the quantity of anesthetic agents required. ⋯ The local administration of bupivacaine for anesthetic purposes before skull-pin application may prevent potentially hazardous hemodynamic stimulation.
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Journal of neurosurgery · Jun 2003
Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model.
The authors attempted to determine independent predictors that contribute to the recurrence of chronic subdural hematoma (CSDH). ⋯ As previously reported, the width of the hematoma is related to the incidence of CSDH recurrence. In this study, the lack of a multiplicity of hematoma cavities was the favorite predictor of CSDH recurrence. In addition, histories of seizure and no past DM are closely related to the incidence of CSDH recurrence.
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Journal of neurosurgery · Jun 2003
Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project.
In many new clinical trials of patients with malignant gliomas surgical intervention is incorporated as an integral part of tumor-directed interstitial therapies such as gene therapy, biodegradable wafer placement, and immunotherapy. Assessment of toxicity is a major component of evaluating these novel therapeutic interventions, but this must be done in light of known complication rates of craniotomy for tumor resection. Factors predicting neurological outcome would also be helpful for patient selection for surgically based clinical trials. ⋯ Perioperative complications occur slightly more often following a second craniotomy for malignant glioma than after the first craniotomy. This should be considered when evaluating toxicities from intraoperative local therapies requiring craniotomy. Nevertheless, most patients are neurologically stable or improved after either their first or second craniotomy. This data set may serve as a benchmark for neurosurgeons and others in a discussion of operative risks in patients with malignant gliomas.
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Journal of neurosurgery · Jun 2003
Case ReportsNonlesional central lobule seizures: use of awake cortical mapping and subdural grid monitoring for resection of seizure focus.
Surgical treatment options for intractable seizures caused by a nonlesional epileptogenic focus located in the central sulcus region are limited. The authors describe an alternative surgical approach for treating medically refractory nonlesional perirolandic epilepsy. ⋯ A limited resection of the sensorimotor cortex may be performed with acceptable neurological morbidity in patients with medically refractory perirolandic epilepsy. This procedure is an alternative to multiple subpial transections in the surgical management of intractable nonlesional epilepsy originating from the sensorimotor cortex.