Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 1996
ReviewJugular bulb oximetry for the monitoring of cerebral blood flow and metabolism.
Jugular bulb oximetry can be used to assess the balance between oxygen supply and demand to the brain, measure metabolic byproducts, and determine cerebral blood flow. It has been useful in guiding the management of patients who are at risk of developing global ischemia. ⋯ Technical considerations such as placement techniques, factors affecting accuracy, limitations of the technique, and proper interpretation of oximetric values are reviewed. Lastly, specific clinical applications are presented.
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It has been the goal of this article to provide the reader with a brief background of fMRI, a basic understanding of the techniques of fMRI, and, more importantly, the potential for clinical and experimental studies using fMRI. In contrast to the limited number of installed PET and MEG units, the large installed base of MR imaging scanners (over 1000 installed at least at 1.5 T in the United States) makes fMRI potentially widely available. ⋯ The areas of language lateralization and memory are still preliminary at best. As methods to reduce the effects of head motion (due to both bulk head motion and physiologically induced motion) arise, the reliability of fMRI should improve, allowing for more definitive identification of task activation.
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In large medical centers, the availability of radiosurgery has relegated brachytherapy to a lesser role in the treatment of newly diagnosed solitary brain metastases. However, the treatment planning in radiosurgery is complex, and in some case the hardware is prohibitively expensive; low or high dose rate brachytherapy requires only a stereotactic frame, commercially available software, and encapsulated radionuclides or newer tiny linear accelerators. Interstitial brachytherapy also remains an option for the treatment of recurrent solitary metastases when other forms of treatment have failed. This article reviews the radiobiology of low and high dose rate interstitial brachytherapy, the University of California San Francisco (UCSF) results using iodine-125 implants, and early experience with the photon radiosurgery system (PRS) at Massachusetts General Hospital for the treatment of brain metastases.
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Interactive image-guided techniques used in conjunction with three-dimensional images allow accurate planning and performance of a variety of neurosurgical procedures. The authors have used the frameless stereotactic Allegro Viewing Wand System to provide real-time correlation of the operating field and computerized images in over 200 neurosurgical operations carried out for intractable epilepsy. The authors experience shows that the viewing wand system is most helpful as an adjunctive navigational device in the microsurgical treatment of epilepsy.
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The most important determinant of successful treatment in all spinal disorders is accurate diagnosis. Diagnostic injection procedures, such as facet blocks, selective nerve root blocks, and discography can aid in accurately diagnosing the source of a patient's pain.