Articles: surgery.
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Injuries of the posterior pelvic with combined anterior and posterior instability require the stabilisation of both the anterior and posterior pelvic ring. If the injury only involves the ligamental connections, then a transileosacral osteosynthesis with screws is the minimal invasive and biomechanically suitable method of choice. The difficulty with this approach is the correct placement of the screws. ⋯ The postoperative CT scans showed no intraspinal or intraforminal malplacement of the screws. In two cases a slight tangential screwthread penetration through the ventral sacrum was found. Our first experiences with this novel technology are encouraging and clearly demonstrate the advantages of fluoroscopic supported passive navigation systems for the optimal placement of ileosacral screws.
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J. Neurol. Neurosurg. Psychiatr. · Feb 2002
Comparative StudyLocalisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somatosensory evoked potentials.
Intraoperative localisation of the sensorimotor cortex using the phase reversal of somatosensory evoked potentials (SEPs) is an essential tool for surgery in and around the perirolandic gyri, but unsuccessful and perplexing results have been reported. This study examines the effect of tumour masses on the waveform characteristics and feasibility of SEP compared with functional neuronavigation and electrical motor cortex mapping. ⋯ The SEP phase reversal of N20-P20 is a simple and reliable technique, but the success rate is much lower in large central and postcentral tumours. With the use of polyphasic late waveforms the sensorimotor cortex may be localised. By contrast with motor electrical mapping it is less time consuming. Functional neuronavigation is a desirable tool for both preoperative surgical planning and intraoperative use during surgery on perirolandic tumours, but compensation for brain shift, accuracy, and cost effectiveness are still a matter for discussion.
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The effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the internal pallidum (GPi) on the parkinsonian triad and on levodopa-induced dyskinesias are very similar. The antiakinetic effect of STN DBS seems to be slightly better. On the contrary to pallidal DBS, stimulation of the STN allows to reduce dopaminergic treatment by more than 50p.100 on average. ⋯ It is the responsibility of the operating centre to determine the levodopa response, to confirm the diagnosis, to rule out contraindications and to make sure that the medical treatment cannot be further optimised. Severe surgical complications with permanent sequels are relatively rare, about 1p.100 per implanted side. The patient selection, the precision of the surgery and the quality of the postoperative follow-up are the three main determinants of success.