Neurol Neurochir Pol
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Neurol Neurochir Pol · Jan 2003
[Awake craniotomy and brain mapping for eloquent cortex in patients with supratentorial tumors: a preliminary report].
Malignant brain tumours are incurable at present. Since none of the hitherto used treatment methods allows to significantly extend these patients' survival time, the basic aim is to improve their quality of life. Intraoperative brain mapping seems to be an approach enabling to minimize the risk of irreversible damages to functionally important structures of the brain. ⋯ In 8 out of the 11 awakened patients intraoperative brain mapping had a significant effect on the course of surgery (i.e. on the resection magnitude and "safe corridor"). Out of six patients with tumors situated in the neighbourhood of motor cortex--one developed a severe and permanent paresis of the upper limb. On the grounds of the literature and the authors' own experience an algorithm of awake craniotomy and intraoperative brain mapping was worked out.
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Neurol Neurochir Pol · Jan 2003
[Direct trans-sylvian approach to the ventrolateral pons in surgical management of large cystic cavernous malformations of the brain stem in children].
In the study surgical indications are reviewed and the effect of the applied surgical technique on long-term treatment outcome in children with large cystic brainstem cavernous malformations is evaluated. ⋯ The findings suggest that resection of large pontine cavernomas in children is indicated in cases of symptomatic hemorrhage with lesions approaching the pial surface, or surrounded by a small margin of normal tissue. Recurrent hemorrhages are intralesional (i.e. limited to pontine structures by the natural anatomical barriers), resulting in a "cyst-like" growth of malformations mimicking that of focal neoplasms and in compression of the brain stem tissue rather than in a direct hemorrhagic insult.
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Neurol Neurochir Pol · Jan 2003
Clinical Trial[Transcranial color Doppler sonography (TCCD) in the diagnosis of vasospasm in the middle cerebral artery. Evaluation of TCCD diagnostic effectiveness by means of receiver operating characteristics curve (ROC) analysis].
Transcranial Doppler sonography is commonly used for diagnosis of cerebral vasospasm. However, the overall diagnostic performance of this method in detection of arterial narrowing has not been established. Blood velocity threshold, diagnostic for vasospasm, has been proposed for conventional, "blind" transcranial Doppler sonography (TCD). ⋯ The best performing TCCD parameter for the detection of MCA narrowing was revealed to be peak-systolic velocity. The optimal trade-off between sensitivity and specificity was achieved with a peak systolic velocity of 182 cm/s. Therefore this velocity threshold is proposed as most universal for the diagnosis of vasospasm in the middle cerebral artery.
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Neurol Neurochir Pol · Jan 2003
[Angio-MR assessment of vasomotor reactivity impairment as a long-term outcome of SAH following intracerebral aneurysm rupture].
Studies on long-term outcome of subarachnoid hemorrhage (SAH) have been carried out for many years using various neuroimaging techniques, such as e.g.: SPECT, PET, TCD and XeCT. In our study angio-MRI supplemented with the acetazolamide test was used to assess cerebrovascular reserve impairment in 30 patients within 6 months since clipping an intracranial aneurysm. ⋯ Cereberovascular reserve evaluated at the follow-up in hypercapneal conditions was found to be insufficient. The degree of vessel reactivity dysfunction as a long-term outcome of SAH turned out to depend on massiveness of hemorrhage from the ruptured aneurysm.
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Neurol Neurochir Pol · Jan 2003
Case Reports[Post-traumatic unilateral atlanto-axial rotatory subluxation in an adult].
This retrospective single-patient case report deals with a rare form of spinal trauma, i.e. atlantoaxial rotatory subluxation. The authors present a review of the literature including a classification of rotatory atlantoaxial subluxation types proposed by Fielding, and describe their own experience with treatment of this condition. A case is reported of a 29-year-old woman with a history of head contusion in a car accident. ⋯ At follow-up certain limitation of neck movements due to C1-C2 stabilization persisted. No complications were noted. The patient remains neurologically intact and has radiographic documentation of fusion.