Journal of neurosurgery
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Journal of neurosurgery · Jul 2011
Clinical TrialQuantitative fluorescence in intracranial tumor: implications for ALA-induced PpIX as an intraoperative biomarker.
Accurate discrimination between tumor and normal tissue is crucial for optimal tumor resection. Qualitative fluorescence of protoporphyrin IX (PpIX), synthesized endogenously following δ-aminolevulinic acid (ALA) administration, has been used for this purpose in high-grade glioma (HGG). The authors show that diagnostically significant but visually imperceptible concentrations of PpIX can be quantitatively measured in vivo and used to discriminate normal from neoplastic brain tissue across a range of tumor histologies. ⋯ These findings are clinically profound because they demonstrate that ALA-induced PpIX is a targeting biomarker for a variety of intracranial tumors beyond HGGs. This study is the first to measure quantitative ALA-induced PpIX concentrations in vivo, and the results have broad implications for guidance during resection of intracranial tumors.
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Journal of neurosurgery · Jul 2011
Comparative StudyLaparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases.
Traditional ventriculoperitoneal (VP) shunt surgery involves insertion of the distal catheter by minilaparotomy. However, minilaparotomy may be a significant source of morbidity during shunt surgery. Laparoscopic insertion of the distal catheter is an alternative technique that may simplify and improve the safety of shunt surgery. ⋯ To our knowledge this is the largest reported comparison of distal VP shunt catheter insertion techniques. Compared with minilaparotomy, the laparoscopic approach was associated with decreased time in the operating room and a decreased LOS. Moreover, laparoscopy was associated with fewer distal shunt obstructions. Laparoscopic shunt surgery is a viable alternative to traditional shunt surgery.
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Journal of neurosurgery · Jul 2011
Utility of diffusion tensor imaging in the acute stage of mild to moderate traumatic brain injury for detecting white matter lesions and predicting long-term cognitive function in adults.
Traumatic brain injury (TBI) often impairs cognitive function. Diffusion tensor (DT) imaging, a novel modality, permits evaluation of the effects of head trauma on white matter nerve fibers. The objectives of the current study were to investigate where the white matter injury following mild to moderate TBI is specifically located on DT imaging in the acute disease stage and to examine the relationship between the severity of the white matter lesion on DT imaging in the acute stage of TBI and future cognitive function in the chronic disease stage. ⋯ Fractional anisotropy reductions in the splenium and FWM in the acute stage of mild to moderate TBI may be a useful prognostic factor for long-term cognitive dysfunction.