Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2003
Clinical TrialEffects of musicokinetic therapy and spinal cord stimulation on patients in a persistent vegetative state.
We developed a method of musicokinetic therapy (MKT), employing a trampoline with live music performance (saxophone or electric piano), in an attempt to improve the clinical condition of patients in a persistent vegetative state (PVS). As an initial step for assessing the effect of MKT on PVS. we analyzed the changes in PVS score (range: 0-30) after MKT, which was continued for 3 months, in a consecutive series of 26 patients. These patients fulfilled the definition of PVS adopted by the Multi-Society Task Force on PVS. ⋯ The improvement in PVS score was often noted in patients with brain damage caused by trauma or SAH. There was no significant difference in improvement of the PVS score between patients who were treated by spinal cord stimulation and those who were not. Although the present study did not directly prove an effect of MKT on PVS, because no controls were involved, the results were consistent with the hypothesis that MKT is useful for improving the clinical condition of patients in PVS, especially those with severe brain damage caused by trauma or SAH.
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Acta Neurochir. Suppl. · Jan 2003
The roles of functional MRI in MR-guided neurosurgery in a combined 1.5 Tesla MR-operating room.
During MR-guided neurosurgical procedures performed in a combined 1.5 Tesla MR-operating room (MR-OR), we have successfully implemented and validated a functional MRI (fMRI) scheme for efficiently localizing eloquent functional areas and assessing their proximity to a lesion volume immediately prior to the craniotomy. ⋯ Intra-operative fMRI can be an indispensable tool for determining the location of a neighboring eloquent functional area of concern in reference to a targeted lesion. Information provided by fMRI has helped in improving the outcome and clinician confidence of all surgeries performed.
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Acta Neurochir. Suppl. · Jan 2003
Early use of intrathecal baclofen in brain injury in pediatric patients.
The Food and Drug Administration (FDA) approved the use of intrathecal Baclofen for spasticity from traumatic brain injury in June of 1996 based on a Phase III clinical trial that documented efficacy in patients one year post injury. The FDA approval is only for patients who are one year post injury based on the Phase III study. We have found use of ITB in the first few months after injury very effective in a subgroup of severe traumatic brain injury (TBI) pediatric patients with spasticity, dystonia and autonomic storming following brain injury. ⋯ Early use of ITB can play a significant role in the rehabilitation of brain injury in children.
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Acta Neurochir. Suppl. · Jan 2003
The importance of decompressive craniectomy for the management of severe head injuries.
Neurosurgical therapy aims to minimize the secondary brain damage after a severe head injury. This includes the evacuation of an intracranial space occupying bleeding, the reduction of intracranial volumes, in hematocephalus an external ventricular drainage, and the conservative therapy in order to influence an increased intracranial pressure (ICP) and a decreased p(ti)02. ⋯ The prognosis after decompression depends on the clinical signs and symptoms on admission, the patients age and the existence of major extracranial injuries. Our guidelines for an indication for decompressive craniectomy after failure of conservative interventions and evacuation of space occupying hematomas include a patients age below 50 years without multiple trauma, a patients age below 30 years in the presence of major extracranial injuries, a severe brain swelling on CT scan, the exclusion of a primary brainstem lesion or injury and the intervention before irreversible brainstem damage and secondarily while monitoring ICP and p(ti)02 in an interval up to 48 hours after the accident before irreversible brainstem damage or generalized brain damage has occurred.
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Acta Neurochir. Suppl. · Jan 2003
Characteristics of parietal-parasagittal hemorrhage after mild or moderate traumatic brain injury.
The aim of this study is to clarify the clinical characteristics of parietal-parasagittal traumatic intracranial hemorrhage (TICH) after mild or moderate traumatic brain injury (TBI). METHODS; Subjects were 105 patients with mild or moderate TBI. The patients with parietal-parasagittal TICH were clinically analyzed based on the initial brain CT findings, hematoma sites and the clinical course as compared to those with TICH at other sites. ⋯ The incidence of parietal-parasagittal TICH is low, but the risk of neurological deterioration due to hematoma enlargement is significantly high. Parietal-parasagittal TICH may differ clinically from frontal-temporal TICH.