Journal of neurosurgery
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Journal of neurosurgery · Oct 2009
Development of the Wireless Instantaneous Neurotransmitter Concentration System for intraoperative neurochemical monitoring using fast-scan cyclic voltammetry.
Emerging evidence supports the hypothesis that modulation of specific central neuronal systems contributes to the clinical efficacy of deep brain stimulation (DBS) and motor cortex stimulation (MCS). Real-time monitoring of the neurochemical output of targeted regions may therefore advance functional neurosurgery by, among other goals, providing a strategy for investigation of mechanisms, identification of new candidate neurotransmitters, and chemically guided placement of the stimulating electrode. The authors report the development of a device called the Wireless Instantaneous Neurotransmitter Concentration System (WINCS) for intraoperative neurochemical monitoring during functional neurosurgery. This device supports fast-scan cyclic voltammetry (FSCV) at a carbon-fiber microelectrode (CFM) for real-time, spatially and chemically resolved neurotransmitter measurements in the brain. ⋯ Taken together, these results demonstrate that the WINCS is well suited for intraoperative neurochemical monitoring. It is anticipated that neurotransmitter measurements at an implanted chemical sensor will prove useful for advancing functional neurosurgery.
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Journal of neurosurgery · Oct 2009
Time course for autoregulation recovery following severe traumatic brain injury.
The aim of the present study was to evaluate the time course for cerebral autoregulation (AR) recovery following severe traumatic brain injury (TBI). ⋯ Autoregulation recovery after severe TBI can be delayed, and failure to recover during the 2nd week after injury occurs mainly in patients with a lower Glasgow Coma Scale score, diffuse brain injury, elevated ICP, or unfavorable outcome. The finding suggests that perfusion pressure management should be considered in some of the patients for a period of at least 2 weeks.
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Journal of neurosurgery · Oct 2009
Prediction of intracranial computed tomography findings in patients with minor head injury by using logistic regression.
The aim of this study was to develop a decision rule for physicians in developing countries to identify patients with minor head injury who will benefit from emergency brain CT scanning. ⋯ The decision rule developed by the authors appears to be 100% sensitive and 46% specific for positive findings on brain CT and will, in developing countries, help clarify the decision to obtain scans.
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Journal of neurosurgery · Oct 2009
Brain tissue oxygen monitoring in traumatic brain injury and major trauma: outcome analysis of a brain tissue oxygen-directed therapy.
Cerebral ischemia is the leading cause of preventable death in cases of major trauma with severe traumatic brain injury (TBI). Intracranial pressure (ICP) control and cerebral perfusion pressure (CPP) manipulation have significantly reduced the mortality but not the morbidity rate in these patients. In this study, the authors describe their 5-year experience with brain tissue oxygen (PbtO(2)) monitoring, and the effect of a brain tissue oxygen-directed critical care guide (PbtO(2)-CCG) on the 6-month clinical outcome (based on the 6-month Glasgow Outcome Scale score) in patients with TBIs. ⋯ The prevention and aggressive treatment of cerebral hypooxygenation and control of ICP with a PbtO(2)-directed protocol reduced the mortality rate after TBI in major trauma, but more importantly, resulted in improved 6-month clinical outcomes over the standard ICP/CPP-directed therapy at the authors' institution.
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Journal of neurosurgery · Oct 2009
Sensitivity of high-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled-gradient recalled imaging in the prediction of neurovascular compression in patients with hemifacial spasm.
Hemifacial spasm is a clinical syndrome caused by vascular compression of the facial nerve in the cerebellopontine angle, which can be relieved by surgical intervention. Advances in medical imaging technology allow for direct visualization of the offending blood vessels in hemifacial spasm and similar conditions (such as trigeminal neuralgia). The utility of high resolution 3D MR angiography and 3D spoiled-gradient recalled (SPGR) imaging sequences for surgical decision-making in hemifacial spasm, as measured by sensitivity, specificity, and positive and negative predictive values, has not been previously determined. ⋯ Although high-resolution 3D MR angiography and 3D SPGR imaging was helpful in providing information about the anatomical relationship of cranial nerve VII and surrounding blood vessels, the authors determined that in the case of hemifacial spasm these types of imaging did not influence preoperative surgical decisionmaking.