Journal of neurosurgery
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Journal of neurosurgery · Nov 2013
Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid-middle cranial fossa approach.
The goals of this study were to report the clinical presentation, radiographic findings, operative strategy, and outcomes among patients with temporal bone encephaloceles and cerebrospinal fluid fistulas (CSFFs) and to identify clinical variables associated with surgical outcome. ⋯ Patients with temporal bone encephalocele and CSFF commonly present with persistent otorrhea and conductive hearing loss mimicking chronic middle ear disease, which likely contributes to a delay in diagnosis. There is a high prevalence of obesity among this patient population, which may play a role in the pathogenesis of primary and recurrent disease. A middle fossa craniotomy or a combined mastoid-middle fossa approach incorporating a multilayer autologous tissue technique is a safe and reliable method of repair that may be particularly useful for large or multifocal defects. Defect reconstruction using artificial titanium mesh should generally be avoided given increased risks of recurrence and postoperative meningitis.
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Journal of neurosurgery · Nov 2013
Comparative StudyElectrostatic discharges and their effect on the validity of registered values in intracranial pressure monitors.
Intracranial pressure (ICP) monitoring is used extensively in clinical practice, and as such, the accuracy of registered ICP values is paramount. Clinical observations of nonphysiological changes in ICP have called into question the accuracy of registered ICP values. Subsequently, the authors have tried to determine if the ICP monitors from major manufacturers were affected by electrostatic discharges (ESDs), if the changes were permanent or transient in nature, and if the changes were modified by the addition of different electrical appliances normally used in the neurointensive care unit environment. ⋯ These results explain some of the sudden shifts in ICP noted in the clinical setting. However, a clear deflection pattern related to the addition of electrical appliances was not found. The authors recommend instituting policies for reducing the risk of subjecting patients to ESDs in the neurointensive care unit setting.
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Journal of neurosurgery · Nov 2013
Review Case ReportsMassive cerebral involvement in fat embolism syndrome and intracranial pressure management.
Fat embolism syndrome (FES) is a common clinical entity that can occasionally have significant neurological sequelae. The authors report a case of cerebral fat embolism and FES that required surgical management of intracranial pressure (ICP). They also discuss the literature as well as the potential need for neurosurgical management of this disease entity in select patients. ⋯ A good outcome was seen in 57.6% of patients with coma and/or abnormal posturing on presentation and in 90.5% of patients presenting with mild mental status changes, focal deficits, or seizure. In the majority of cases ICP was managed conservatively with no surgical intervention. One case featured the use of an ICP monitor, while none featured the use of hemicraniectomy.
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Journal of neurosurgery · Nov 2013
Cadherin 13 overexpression as an important factor related to the absence of tumor fluorescence in 5-aminolevulinic acid-guided resection of glioma.
Gliomas contain aggressive malignant cancer, and resection rate remains an important factor in treatment. Currently, fluorescence-guided resection using orally administered 5-aminolevulinic acid (5-ALA) has proved to be beneficial in improving the prognosis of patients with gliomas. 5-ALA is metabolized to protoporphyrin IX (PpIX) that accumulates selectively in the tumor and exhibits strong fluorescence upon excitation, but glioma cells do not always respond to 5-ALA, which can result in incomplete or excessive resection. Several possible mechanisms for this phenomenon have been suggested, but they remain poorly understood. To clarify the probable mechanisms underlying the variable induction of fluorescence and to improve fluorescence-guided surgery, the authors searched for key negative regulators of fluorescent signal induced by 5-ALA. ⋯ The cadherin 13 gene might play a role in the PpIX accumulation pathway and act as a negative regulator of 5-ALA-induced fluorescence in glioma cells. Although further studies to clarify the mechanisms of action in the 5-ALA metabolic pathway would be indispensable, the results of this study might lead to a novel fluorescent marker able to overcome the obstacles of existing fluorescence-guided resection and improve the limited resection rate.
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Journal of neurosurgery · Nov 2013
Intracranial biomechanics following cortical contusion in live rats.
The goal of this study was to examine the mechanical properties of living rat intracranial contents and corresponding brain structural alterations following parietal cerebral cortex contusion. ⋯ The viscoelastic properties of living rat brain change following contusion. Initially, edema and tissue necrosis occur, and the brain becomes less elastic and less viscous. Later, along with undergoing reactive astroglial changes, the brain tends to become stiffer than normal. These quantitative data, which are related to the physical changes in the brain following trauma and which reflect subjective impressions upon palpation, will be useful for understanding emerging diagnostic tools such as magnetic resonance elastography.