Journal of neurosurgery
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Journal of neurosurgery · Dec 2002
Clinical and electrophysiological expression of deafferentation pain alleviated by dorsal root entry zone lesions in rats.
The aims of this study were to construct an animal model of deafferentation of the spinal cord by brachial plexus avulsion and to analyze the effects of subsequent dorsal root entry zone (DREZ) lesions in this model. To this end, the authors measured the clinical and electrophysiological effects of total deafferentation of the cervical dorsal horn in rats and evaluated the clinical efficacy of cervical DREZ lesioning. ⋯ These results emphasize the role of the spinal dorsal horn in the genesis of deafferentation pain and suggest that dorsal horn deafferentation by cervical posterior rhizotomy in the rat provides a reliable model of chronic pain due to brachial plexus avulsion and its suppression by MDR.
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Journal of neurosurgery · Dec 2002
Implantation of deep brain stimulation electrodes in unshaved patients. Technical note.
Although hair removal prior to neurosurgery may increase the risk of infection, the practice of shaving the patient's entire head is still common, particularly in implant surgery. The authors describe a technique for implanting a deep brain stimulation electrode without shaving the patient's hair and present a retrospective analysis of 261 implantations in 221 cases.
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Journal of neurosurgery · Dec 2002
Hemorrhage risks and obliteration rates of arteriovenous malformations after gamma knife radiosurgery.
The purpose of this study was to analyze the risk of hemorrhage and the obliteration rate after treatment of patients with arteriovenous malformations (AVMs). ⋯ Moyamoya-type AVMs seem to be at risk for post-GKS hemorrhage. Intravascular embolization should be considered prior to GKS for mixed- and shunt-type AVMs in an attempt to reduce the hemodynamic stress and thereby decrease the risk of hemorrhage.
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Journal of neurosurgery · Nov 2002
Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression therapy in controlling intracranial pressure after head injury.
Hyperventilation therapy, blood pressure augmentation, and metabolic suppression therapy are often used to reduce intracranial pressure (ICP) and improve cerebral perfusion pressure (CPP) in intubated head-injured patients. In this study, as part of routine vasoreactivity testing, these three therapies were assessed in their effectiveness in reducing ICP. ⋯ Of the three modalities tested to reduce ICP, hyperventilation therapy was the most consistently effective, metabolic suppression therapy was variably effective, and induced hypertension was generally ineffective and in some instances significantly raised ICP. The results of this study suggest that hyperventilation may be used more aggressively to control ICP in head-injured patients, provided it is performed in conjunction with monitoring of SjvO2.
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Journal of neurosurgery · Nov 2002
Preoperative ventriculostomy and rebleeding after aneurysmal subarachnoid hemorrhage.
Despite the widespread use of ventriculostomy in the treatment of acute hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH), there is no consensus regarding the risk of rebleeding associated with ventriculostomy before aneurysm repair. This present study was conducted to assess the risk of rebleeding after preoperative ventriculostomy in patients with aneurysmal SAH. ⋯ No evidence was found that preoperative ventriculostomy performed after aneurysmal SAH is associated with an increased risk of aneurysm rebleeding when early aneurysm surgery is performed.