Journal of neurosurgery
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Individual variability in the localization of language, as measured by object-naming, was assessed for left lateral peri-Sylvian cortex with a multi-sample technique of stimulation mapping at a constant current. This study was performed during craniotomy under local anesthesia in 10 patients with medically intractable epilepsy and the usual pattern of left brain dominance for language. A high degree of variability in the exact location of naming was present. ⋯ Elsewhere in language cortex, including all parts of the posterior language area, there was considerable individual variability. Because of this, the classical model of language localization is an inaccurate basis for establishing the risk of aphasia in surgical therapy of dominant hemisphere peri-Sylvian lesions in this and related patient populations. Rather, that risk should be assessed from the individual localization of language, established by the multisample technique of stimulation mapping.
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Journal of neurosurgery · Oct 1978
Neurosurgery: considerations for strength and quality. The 1978 AANS presidential address.
The President of the American Association of Neurological Surgeons reviews the organization of the Association designed to represent neurosurgery and neurosurgeons. He summarizes the pertinent problems that the specialty has faced and with which it continues to deal, in persistent pursuit of its objective: to assure the highest quality of neurosurgical care for all.
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The microsurgical anatomy of the distal anterior cerebral artery (ACA) has been defined in 50 cerebral hemispheres. The distal ACA, the portion beginning at the anterior communicating artery (ACoA), was divided into four segments (A2 through A5) according to Fischer. The distal ACA gave origin to central and cerebral branches. ⋯ The anterior portions of the hemisphere between the 5-cm and 15-cm points on the circumferential line showed the most promise of revealing a recipient artery of sufficient size for an extracranial-intracranial artery anastomosis. The distal ACA was the principal artery supplying the corpus callosum. The recurrent artery, which arose from the A2 segment in 78% of hemispheres, sent branches into the subcortical area around the anterior limb of the internal capsule.
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Journal of neurosurgery · May 1978
Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury.
Regional cerebral blood flow (rCBF), cerebral intraventricular pressure (IVP), systemic arterial blood pressure, and cerebral ventricular fluid (CSF) lactate and pH were studied repeatedly in 23 patients during the acute phase of severe brain injury lasting from 3 to 21 days after the trauma. Cerebrovascular autoregulation was tested repeatedly by means of angiotensin infusion in 21 of the patients, and CO2 response in 14 by means of passive hyperventilation. The pressure in the brain ventricles was measured continuously in all patients and kept below 45 mm Hg during the study. ⋯ The CO2 response was impaired only in patients who were deeply comatose and had attacks of decerebrate rigidity; during recovery the CO2 response became normal. Thus, preserved autoregulation associated with imparied CO2 response indicated very severe brain damage, whereas impaired autoregulation associated with preserved CO2 response suggested moderate or severe brain damage in recovery. These paradoxical observations raise the question whether the preserved autoregulation seen in severely injured brain tissue is a true autoregulation caused by an active vasoconstrictor response to an increase in blood pressure.