Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Bumping phenomenon during continuous coagulation with bipolar forceps.
During continuous bipolar coagulation, the coagulum sometimes ruptures suddenly and audibly, leading to hemostasis failure and damage to the surrounding tissues. Such coagulum rupture is a phenomenon that is similar to microwave bumping, which occurs because of unequal heat distribution as a result of sudden elevation in temperature. The present study investigated the conditions under which bumping can occur during bipolar coagulation using samples of whole blood. ⋯ Furthermore, bumping during coagulation could be prevented if the tips of the forceps at the coagulation site were repeatedly opened and closed. The bumping phenomenon is influenced by various factors such as heat, electrical power, equipment, and coagulation technique. Neurosurgeons should understand the technical certain aspects of these surgical tools and develop appropriate advanced techniques for temperature control.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Review Case ReportsNontraumatic cervical disc herniation in a 21-year-old patient with no other underlying disease.
A 21-year-old woman presented with cervical myelopathy due to nontraumatic cervical disc herniation associated with cervical canal stenosis. The patient underwent removal of the herniated disc and anterior fusion with an autogenous iliac crest bone graft. After surgery, the patient showed satisfactory improvement. ⋯ A history of cervical trauma and preexisting fusion of the cervical spine are risk factors for cervical disc herniation. The present case is the youngest known of nontraumatic disc herniation without other underlying disease. Hypermobility due to neck cracking and a relatively narrow spinal canal might have been important in causing cervical myelopathy by disc herniation.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
ReviewEfficacy and limitations of stereotactic radiosurgery in the treatment of glioblastoma.
Treatment of recurrent glioblastoma is still challenging. Stereotactic radiosurgery has been accepted as a treatment option for recurrent glioblastoma after standard chemotherapy and irradiation. However, the efficacy of stereotactic radiosurgery at recurrence has been limited, mainly due to the highly infiltrative nature of the tumor which makes the lesion difficult to define as the target. ⋯ Radiation-induced adverse event is another problem after stereotactic radiosurgery for recurrent glioblastoma because almost all patients underwent irradiation as a part of the initial treatment. To overcome the side effects associated with re-irradiation, use of bevacizumab, a humanized monoclonal antibody to vascular endothelial growth factor, has shown some efficacy. Advances in irradiation technology, neuroimaging, and adjuvant treatment are needed to enhance the efficacy of stereotactic radiosurgery for recurrent glioblastoma and reduce the morbidity associated with irradiation.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
ReviewNeuroendoscopic transnasal surgery for skull base tumors: basic approaches, avoidance of pitfalls, and recent innovations.
Since the introduction of endoscopic technology in the neurosurgical field, the role of transnasal surgery has been dramatically enlarged. With this technique, we can approach the anterior cranial base, parasellar region, clivus, cavernous sinus, and craniovertebral junction, less invasively than with conventional microsurgery. This review describes the two major approach methods in endoscopic skull base surgery, the endonasal approach and the transseptal approach. ⋯ The endoscopic skull base approach is one of the least invasive surgical procedures, which is a very promising therapeutic choice with potential for further advances. For better surgical outcomes and further progress, cooperation with rhinolaryngologists who have much more knowledge and experience about nasal surgery than neurosurgeons is essential. We believe this article will contribute to the development of safe and effective surgical procedures, and to the benefit of the patients suffering with intractable skull base lesions.
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Neurol. Med. Chir. (Tokyo) · Jan 2012
Clinical TrialSpinal cord stimulation for treatment of patients in the minimally conscious state.
Minimally conscious state (MCS) is characterized by inconsistent but clearly discernible behavioral evidence of consciousness, and can be distinguished from coma and the vegetative state (VS). Ten MCS patients were evaluated neurologically and electrophysiologically over 3 months after the onset of brain injury, and were treated by spinal cord stimulation (SCS). A flexible four-contact, cylinder electrode was inserted into the epidural space of the cervical vertebrae, and placed at the C2-C4 levels. ⋯ Cervical SCS increased cerebral blood flow (CBF) diffusely in the brain, and CBF increased by 22.2% during the stimulation period compared with CBF before stimulation in MCS patients (p < 0.0001, paired t-test). Five-Hz cervical SCS could increase CBF and induce muscle twitches of the upper extremities. This SCS therapy method may be suitable for treating MCS.