Neurosurgery
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The introduction of intraoperative 1.5-T magnetic resonance imaging may provide up-to-date functional information in the surgical environment. However, feasible passive paradigms that allow the examination of anesthetized patients will be a precondition for intraoperative functional magnetic resonance imaging (fMRI). The aim of this study is to evaluate the feasibility of a recently developed passive fMRI paradigm for functional neuroimaging in anesthetized patients. ⋯ The method presented proved to be a feasible paradigm for fMRI evaluation of the sensorimotor cortex in anesthetized patients and thus forms a relevant step toward real intraoperative functional neuroimaging.
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The transoral approach to the odontoid process is considered the "gold standard" for resection of extradural lesions at this location. A completely transnasal endoscopic approach is feasible based on anatomic studies and our experience with the expanded endonasal approach for neoplasms of the cranial base. An illustrative case is presented to demonstrate the technical details of a fully transnasal completely endoscopic approach for the resection of the odontoid process. ⋯ Complete resection of the odontoid was achieved with no significant morbidity. This is the first reported case of a completely endoscopic resection of the odontoid using a fully transnasal route. The report demonstrates the feasibility of this approach and larger clinical series with long-term follow-up will be needed to determine the reproducibility and validation of any potential benefits.
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Clinical Trial
Localized transcranial electrical motor evoked potentials for monitoring cranial nerves in cranial base surgery.
To describe a novel monitoring technique that allows "functional" assessment of cranial nerve continuity during cranial base surgery. ⋯ Facial nerve MEPs recorded intraoperatively during cranial base surgery using the proposed technique predicts immediate postoperative facial nerve outcome. This technique can also be used to monitor other motor cranial nerves in cranial base surgery.
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The purpose of this study was to examine the vascular supply of the anteriorly based frontal pericranial flap to determine whether separating the pericranium from the galea above the orbital rim would devascularize the pericranial flap. ⋯ In preparing a pericranial flap based anteriorly on the supraorbital rim, the separation of the galea-frontalis muscle layer from the pericranium layer should not extend into the 10 mm above the supraorbital rim if the arterial and venous pedicle of the pericranial flap is to be preserved.