Neurological research
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Neurological research · Jan 1999
ReviewEpidural fibrosis and the failed back surgery syndrome: history and physical findings.
Patients who present with recurrent symptoms after surgical intervention aimed at correcting their lumbosacral disease pose a therapeutic challenge. A heterogeneous group of factors may underlie symptom recurrence and formulation of a therapeutic strategy depends on an accurate diagnosis of the patient's underlying problem. In this review, the authors discuss the relevant historical and physical findings in patients with epidural fibrosis and the failed back surgery syndrome.
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Neurological research · Jan 1999
Randomized Controlled Trial Multicenter Study Clinical TrialAssociation between peridural scar and activity-related pain after lumbar discectomy.
The purpose of this study was to investigate the correlation between activity-related pain six months after first surgery for herniated lumbar disc, and the extent of lumbar epidural fibrosis present at the surgical site, assessed by magnetic resonance imaging. The 298 patients who underwent surgery for lumbar disc herniation were studied in a randomized, controlled, double-blind multicenter clinical trial to test the effectiveness of the scar-inhibiting device ADCON-L. Clinical assessments were conducted pre-operatively and at 1, 3, and 6 month intervals post-operatively, and included wound examination, magnetic resonance imaging scar assessment, and the Johns Hopkins activity-related pain questionnaire. ⋯ Repeated measures analysis demonstrated that patients who received treatment with ADCON-L at the time of surgery experienced less activity-related pain through the 12-month assessment (p = 0.05). A significant association between extensive epidural scar and activity-related pain is demonstrated. Patients with less scar had less activity related pain, confirming the finding that the use of the scar inhibitor ADCON-L has a positive effect on surgical outcome.
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Neurological research · Dec 1998
Comparative StudyEffects of mild (33 degrees C) and moderate (29 degrees C) hypothermia on cerebral blood flow and metabolism, lactate, and extracellular glutamate in experimental head injury.
The effects of mild (33 degrees C) and moderate (29 degrees C) hypothermia were investigated to determine which temperature was more effective against compression-induced cerebral ischemia. Eighteen cats were anesthetized. The animals were divided into three groups according to deep-brain temperature (control, 37 degrees C; mild hypothermia, 33 degrees C; and moderate hypothermia, 29 degrees C). ⋯ Extracellular glutamate increased in control animals (3.8 +/- 1.72 microM), an effect most effectively suppressed in the mild hypothermia group (1.0 +/- 0.46 microM). Damaged tissue volumes as indicated by Evans blue dye extravasation were 729 +/- 89 mm3 in control, 247 +/- 56 mm3 in mild hypothermia, and 267 +/- 35 mm3 in moderate hypothermia animals. These data suggest that mild hypothermia (33 degrees C) might be the optimal brain temperature to treat compression-related cerebral ischemia.
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Neurological research · Oct 1998
Lower clivus and foramen magnum anterolateral meningiomas: surgical strategy.
Lower clivus and anterolateral foramen magnum meningiomas are rare but challenging tumors. Indeed, all access routes to their intradural anterolateral implantation appear unsafe since highly-functional local structures may not be sacrified or even retracted. Anterior and posterior surgical approaches have specific advantages and limitations. ⋯ They include a transposition of the vertebral artery, a partial occipital condylectomy and even the exposure and the section of the sigmoid sinus. Such posterolateral approaches offer the optimal access to anterolateral foramen magnum meningiomas and allow a total removal with a minimal morbidity. We report the surgical strategy that we applied for the last 6 anterolateral foramen magnum meningiomas in our department.
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Neurological research · Sep 1998
Intracranial pressure waveform analysis: computation of pressure transmission and waveform shape indicators.
We studied transmission of arterial blood pressure to intracranial pressure by observing how the two pressure waveforms varied from baseline conditions to after postural change or jugular compression. Such experiments may lead to pressure waveform-based estimates of intracranial compliance. Using a single database of arterial blood pressure, central venous pressure, and intracranial pressure waveforms collected during baseline, jugular compresison, and head-elevated conditions from six Yucatan minipigs, we computed several numerical indicators of waveform shape to find an estimator of intracranial compliance. ⋯ The lack of statistically significant results may be due to the nature of the composites and/or the small sample size (n = 6). However, we hope this study stimulates further investigation of both central venous pressure-to-intracranial pressure (in addition to arterial blood pressure-to-intracranial pressure) transfer and automated computation of intracranial pressure waveform systolic slope. Such research may lead to noninvasively determined estimators of intracranial compliance.