Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2003
Comparative StudyPET investigation of post-traumatic cerebral blood volume and blood flow.
Hemodynamic changes following traumatic brain injury (TBI) may reflect cellular damage leading to secondary injury. The purpose of this study was to investigate the regional hemodynamic parameters acutely after TBI among regions in and around contusions. Sixteen patients (11 male, 5 female) showing evidence of contusion on CT and 18 normal volunteers (12 male, 6 female) underwent positron emission tomography (PET) with O-15 CO and O-15 H2O to estimate cerebral blood volume (CBV) and cerebral blood flow (CBF), respectively. ⋯ The correlation between CBF and CBV was significant (r = 0.37, p < 0.01). Remote areas did not show a significant difference in any of the PET parameters. In conclusion, regional brain edema is likely to occur in contusion and pericontusion areas, while some of the contusional tissue may show vascular engorgement.
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Acta Neurochir. Suppl. · Jan 2003
ReviewOncolytic viruses for treatment of malignant brain tumours.
Wild type viruses have been known for decades for their capability to destroy malignant tumour cells upon infection and intracellular replication. Genetic engineering of such viruses was, however, only recently done in an attempt to improve their utility as biological anticancer agents. Wild type or recombinant viruses able to selectively destroy tumour cells while sparing normal tissue are known as oncolytic viruses. ⋯ In malignant glioma, standard gene therapy approaches employing non-replicating virus vectors failed to demonstrate significant benefit in clinical studies. Therapy with oncolytic viruses seems to hold more promise in early clinical trials than gene therapy with non-replicating virus vectors. However, further major advancements in virus designs, application modalities, and understanding of the interactions of the host's immune system with the virus are clearly needed before oncolytic virus therapy of malignant brain tumours can be introduced to clinical practice.
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Acta Neurochir. Suppl. · Jan 2003
MR safety in patients with implanted deep brain stimulation systems (DBS).
While it is desirable to perform MRI examinations in patients with deep brain stimulators (DBS), a major safety concern exists regarding the potential for excessive heating secondary to magnetically induced electrical currents. This study was designed to determine the safety of MRI and DBS. ⋯ Excessive heating does occur with certain MR imaging conditions. Under certain conditions determined in this study, patients with DBS may safely undergo anatomical MR imaging. In the future, standardized testing and more comprehensive studies will be needed to ensure the MR safety of neurostimulation systems.
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Acta Neurochir. Suppl. · Jan 2003
Clinical TrialCombined dorsal root entry zone lesions and neural reconstruction for early rehabilitation of brachial plexus avulsion injury.
Brachial plexus avulsion injury is one of the major complications after traffic, especially motorcycle accidents. During the past 12 years, we have encountered more than 40 brachial plexus avulsion injuries. The neurological deficits included pain and paralysis of the damaged limb. ⋯ Six patients showed good functional result after reconstruction. Three had no improvement. Combined pain control and reconstruction offer an early rehabilitation for brachial plexus avulsion injury.
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Acta Neurochir. Suppl. · Jan 2003
Continuous assessment of cerebral autoregulation: clinical and laboratory experience.
The method for the continuous assessment of cerebral autoregulation using slow waves of MCA blood flow velocity (FV) and cerebral perfusion pressure (CPP) or arterial pressure (ABP) has been introduced seven years ago. We intend to review its clinical applications in various scenarios. Moving correlation coefficient (3-6 min window), named Mx, is calculated between low-pass filtered (0.05 Hz) signals of FV and CPP or ABP (when ICP is not measured directly). ⋯ In head injury, Mx indicated disturbed autoregulation with low CPP (< 55 mmHg) and too high CPP (> 95 mmHg). Mx strongly discriminated between patients with favourable and unfavourable outcome (p < 0.00002). This method can be used in many clinical scenarios for continuous monitoring of cerebral autoregulation, predicting outcome and optimising treatment strategies.