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Accreditation of neurosurgical training programmes in Europe: Report of JRAAC 
Accreditation of neurosurgical training programmes in Europe: Report of JRAAC
- Content Type Journal Article
- DOI 10.1007/s00701-010-0782-7
(03/09/2010 @ 17:23)
A. R. Crossman, D. Neary, Neuroanatomy. An illustrated colour text
A. R. Crossman, D. Neary, Neuroanatomy. An illustrated colour text
- Content Type Journal Article
- DOI 10.1007/s00701-010-0712-8
- Authors
- N. Tribolet, Neurochirurgie, HUG, 1211 Geneva, Switzerland
(03/09/2010 @ 17:23)
Regression of meningiomas after discontinuation of cyproterone acetate in a transsexual patient
Regression of meningiomas after discontinuation of cyproterone acetate in a transsexual patient
- Content Type Journal Article
- DOI 10.1007/s00701-010-0787-2
- Authors
- Helene Cebula, Department of Neurosurgery, Strasbourg University Hospital, Service de Neurochirurgie, CHU de Hautepierre, 1 avenue Molière, 67200 Strasbourg, France
- Trang Q. Pham, Department of Neurosurgery, Strasbourg University Hospital, Service de Neurochirurgie, CHU de Hautepierre, 1 avenue Molière, 67200 Strasbourg, France
- Patrick Boyer, Department of Neurosurgery, Strasbourg University Hospital, Service de Neurochirurgie, CHU de Hautepierre, 1 avenue Molière, 67200 Strasbourg, France
- Sébastien Froelich, Department of Neurosurgery, Strasbourg University Hospital, Service de Neurochirurgie, CHU de Hautepierre, 1 avenue Molière, 67200 Strasbourg, France
... / ... 
Regression of meningiomas after discontinuation of cyproterone acetate in a transsexual patient
Regression of meningiomas after discontinuation of cyproterone acetate in a transsexual patient
- Content Type Journal Article
- DOI 10.1007/s00701-010-0787-2
- Authors
- Helene Cebula, Department of Neurosurgery, Strasbourg University Hospital, Service de Neurochirurgie, CHU de Hautepierre, 1 avenue Molière, 67200 Strasbourg, France
- Trang Q. Pham, Department of Neurosurgery, Strasbourg University Hospital, Service de Neurochirurgie, CHU de Hautepierre, 1 avenue Molière, 67200 Strasbourg, France
- Patrick Boyer, Department of Neurosurgery, Strasbourg University Hospital, Service de Neurochirurgie, CHU de Hautepierre, 1 avenue Molière, 67200 Strasbourg, France
- Sébastien Froelich, Department of Neurosurgery, Strasbourg University Hospital, Service de Neurochirurgie, CHU de Hautepierre, 1 avenue Molière, 67200 Strasbourg, France
(02/09/2010 @ 16:57)
Molecular genetics, imaging and treatment of oligodendroglial tumours
Abstract The discovery of a genetic signature of chemosensitivity and prognosis in oligodendroglial tumours prompted a new optimism
in glioma management. After more than a decade since the initial reports, where do we stand in the current management of oligodendroglial
tumours? This review focuses on the latest molecular genetics, imaging characteristics, and recent trials of treatment paradigms
for these tumours.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0784-5
- Authors
- Michael D. Jenkinson, Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ UK
- Carol Walker, School of Cancer Studies, University of Liverpool, Liverpool, L3 5UZ UK
- Andrew R. Brodbelt, Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ UK
- Simone Wilkins, School of Cancer Studies, University of Liverpool, Liverpool, L3 5UZ UK
- David Husband, Clatterbridge Centre for Oncology, Clatterbridge Hospital, Bebington, Wirral, CH63 4JY UK
- Brian Haylock, Clatterbridge Centre for Oncology, Clatterbridge Hospital, Bebington, Wirral, CH63 4JY UK
... / ...
Molecular genetics, imaging and treatment of oligodendroglial tumours
Abstract The discovery of a genetic signature of chemosensitivity and prognosis in oligodendroglial tumours prompted a new optimism
in glioma management. After more than a decade since the initial reports, where do we stand in the current management of oligodendroglial
tumours? This review focuses on the latest molecular genetics, imaging characteristics, and recent trials of treatment paradigms
for these tumours.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0784-5
- Authors
- Michael D. Jenkinson, Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ UK
- Carol Walker, School of Cancer Studies, University of Liverpool, Liverpool, L3 5UZ UK
- Andrew R. Brodbelt, Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool, L9 7LJ UK
- Simone Wilkins, School of Cancer Studies, University of Liverpool, Liverpool, L3 5UZ UK
- David Husband, Clatterbridge Centre for Oncology, Clatterbridge Hospital, Bebington, Wirral, CH63 4JY UK
- Brian Haylock, Clatterbridge Centre for Oncology, Clatterbridge Hospital, Bebington, Wirral, CH63 4JY UK
(02/09/2010 @ 08:31)
Needle insertion in the foramen ovale
Needle insertion in the foramen ovale
- Content Type Journal Article
- DOI 10.1007/s00701-010-0768-5
- Authors
- Ignacio Arrese, Department of Neurosurgery, Hospital Donostia, San Sebastian, Spain
- Enrique Úrculo, Department of Neurosurgery, Hospital Donostia, San Sebastian, Spain
... / ...
Needle insertion in the foramen ovale
Needle insertion in the foramen ovale
- Content Type Journal Article
- DOI 10.1007/s00701-010-0768-5
- Authors
- Ignacio Arrese, Department of Neurosurgery, Hospital Donostia, San Sebastian, Spain
- Enrique Úrculo, Department of Neurosurgery, Hospital Donostia, San Sebastian, Spain
(02/09/2010 @ 08:31)
Oguz Cataltepe, George I. Gallo, Pediatric epilepsy surgery
Oguz Cataltepe, George I. Gallo, Pediatric epilepsy surgery
- Content Type Journal Article
- DOI 10.1007/s00701-010-0770-y
- Authors
- Karl Schaller, Service de neurochirurgie, Geneva University Hospital, Geneva, Switzerland
(02/09/2010 @ 08:31)
About hierarchical log linear analysis of admission blood parameters and clinical outcome following traumatic brain injury
About hierarchical log linear analysis of admission blood parameters and clinical outcome following traumatic brain injury
- Content Type Journal Article
- DOI 10.1007/s00701-010-0745-z
- Authors
- José Roberto Tude Melo, Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades (Assistance Publique Hôpitaux de Paris
(02/09/2010 @ 08:31)
Dose-dependent ultrastructural and morphometric alterations after erythropoietin treatment in rat femoral artery vasospasm model
Abstract
Purpose Cerebral vasospasm is the common cause of poor outcome after aneurysmal subarachnoid hemorrhage (aSAH). Although many agents
are experimentally and clinicaly used to protect or recover from vasospasm, an effective neurotherapeutic drug is still missing.
Erythropoietin (EPO) is recently a promising candidate. The aim of this study is to investigate the dose-dependent effects
of recombinant human EPO (rhEPO) on arterial wall in a rat femoral artery vasospasm model.
Methods Thirty two animals were divided into four groups: vasospasm without any treatment (group A), vasospasm +250 IU/kg rhEPO group
(group B), vasospasm +500 IU/kg rhEPO group (group C), and control group (group D). Rat femoral artery vasospasm model was
used. For groups B and C, 7 days of 250 IU/kg and 500 IU/kg intraperitoneal rhEPO in 0.3 ml saline were administered respectively;
and for groups A and D, 0.3 ml saline were administered intraperitoneally without any treatment. After 7 days, histological
and morphometric analyses were carried out.
Results Vasospasm alone group demonstrated the highest vessel wall thicknesses, comparing to other groups (p ... / ...
Dose-dependent ultrastructural and morphometric alterations after erythropoietin treatment in rat femoral artery vasospasm model
Abstract
Purpose Cerebral vasospasm is the common cause of poor outcome after aneurysmal subarachnoid hemorrhage (aSAH). Although many agents
are experimentally and clinicaly used to protect or recover from vasospasm, an effective neurotherapeutic drug is still missing.
Erythropoietin (EPO) is recently a promising candidate. The aim of this study is to investigate the dose-dependent effects
of recombinant human EPO (rhEPO) on arterial wall in a rat femoral artery vasospasm model.
Methods Thirty two animals were divided into four groups: vasospasm without any treatment (group A), vasospasm +250 IU/kg rhEPO group
(group B), vasospasm +500 IU/kg rhEPO group (group C), and control group (group D). Rat femoral artery vasospasm model was
used. For groups B and C, 7 days of 250 IU/kg and 500 IU/kg intraperitoneal rhEPO in 0.3 ml saline were administered respectively;
and for groups A and D, 0.3 ml saline were administered intraperitoneally without any treatment. After 7 days, histological
and morphometric analyses were carried out.
Results Vasospasm alone group demonstrated the highest vessel wall thicknesses, comparing to other groups ( p
Elevated peritumoural rCBV values as a mean to differentiate metastases from high-grade gliomas
Abstract
Purpose Increased relative cerebral blood volume (rCBV) was previously found in peritumoural oedema of glioblastomas (GBM). Supposing
that peritumoural rCBV is not increased in metastases, we aimed to evaluate whether rCBV values of the whole peritumoural
area are accurate to differentiate solitary metastasis from GBM irrespective of the peritumoural oedema.
Methods Contrast-enhanced T1-weighted (T1-w) and T2*-weighted dynamic susceptibility contrast MRI was performed in 52 patients with
contrast-enhancing solitary brain tumours before surgery. In each T1-w slice depicting the contrast-enhancing tumour, a rim
within approximately 15 mm was defined in the peritumoural area. The rCBV values were normalised to rCBV values of the contralateral
normal white matter. Differences between metastases and GBM for normalised rCBV values for each slice were determined with
the Mann ... / ...
Elevated peritumoural rCBV values as a mean to differentiate metastases from high-grade gliomas
Abstract
Purpose Increased relative cerebral blood volume (rCBV) was previously found in peritumoural oedema of glioblastomas (GBM). Supposing
that peritumoural rCBV is not increased in metastases, we aimed to evaluate whether rCBV values of the whole peritumoural
area are accurate to differentiate solitary metastasis from GBM irrespective of the peritumoural oedema.
Methods Contrast-enhanced T1-weighted (T1-w) and T2*-weighted dynamic susceptibility contrast MRI was performed in 52 patients with
contrast-enhancing solitary brain tumours before surgery. In each T1-w slice depicting the contrast-enhancing tumour, a rim
within approximately 15 mm was defined in the peritumoural area. The rCBV values were normalised to rCBV values of the contralateral
normal white matter. Differences between metastases and GBM for normalised rCBV values for each slice were determined with
the Mann
Non-ionic contrast media neurotoxicity mimicking intracerebral hematoma
Non-ionic contrast media neurotoxicity mimicking intracerebral hematoma
- Content Type Journal Article
- DOI 10.1007/s00701-010-0780-9
- Authors
- Bora Gürer, 1st Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, 06110 Ankara, Turkey
- Erdal Resit Yilmaz, 1st Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, 06110 Ankara, Turkey
- Ramazan Kahveci, 1st Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, 06110 Ankara, Turkey
- Zeki Sekerci, 1st Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, 06110 Ankara, Turkey
... / ...
Non-ionic contrast media neurotoxicity mimicking intracerebral hematoma
Non-ionic contrast media neurotoxicity mimicking intracerebral hematoma
- Content Type Journal Article
- DOI 10.1007/s00701-010-0780-9
- Authors
- Bora Gürer, 1st Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, 06110 Ankara, Turkey
- Erdal Resit Yilmaz, 1st Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, 06110 Ankara, Turkey
- Ramazan Kahveci, 1st Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, 06110 Ankara, Turkey
- Zeki Sekerci, 1st Neurosurgery Clinic, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, 06110 Ankara, Turkey
(26/08/2010 @ 09:55)
Radial oxygen gradients over rat cortex arterioles
Abstract
Purpose We present the results of the visualisation of radial oxygen gradients in rats ... / ...
Radial oxygen gradients over rat cortex arterioles
Abstract
Purpose We present the results of the visualisation of radial oxygen gradients in rats
Intracranial spontaneous hypotension associated with CSF cervical leakage successfully treated by lumbar epidural blood patch
Intracranial spontaneous hypotension associated with CSF cervical leakage successfully treated by lumbar epidural blood patch
- Content Type Journal Article
- DOI 10.1007/s00701-010-0783-6
- Authors
- Angelo Franzini, Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico
(26/08/2010 @ 09:55)
Working towards patient oriented outcome assessment in normal pressure hydrocephalus, what is the most important?
Abstract
Objective To date, there is no standard outcome assessment scale for shunt treatment in normal pressure hydrocephalus (NPH). In designing
such scale, the relative weight of each of the common presentations of the condition from the patient ... / ...
Working towards patient oriented outcome assessment in normal pressure hydrocephalus, what is the most important?
Abstract
Objective To date, there is no standard outcome assessment scale for shunt treatment in normal pressure hydrocephalus (NPH). In designing
such scale, the relative weight of each of the common presentations of the condition from the patient
A 10-year follow-up of extracranial
Abstract Cervicocephalic fibromuscular dysplasia (FMD) is an idiopathic, non-inflammatory and non-atherosclerotic arteriopathy which
usually affects small- and medium-sized cervical arteries distributed at the atlas and axis interspace. Few cervicocephalic
FMD patients are associated with multiple intracranial aneurysms which may rupture or develop. So the authors describe a cervicocephalic
FMD patient with a history of right oculomotor palsy in 2000. Angiography revealed bilateral internal carotid artery (ICA)
aneurysms and a fusiform aneurysm in right vertebral artery. Typical ... / ...
A 10-year follow-up of extracranial
Abstract Cervicocephalic fibromuscular dysplasia (FMD) is an idiopathic, non-inflammatory and non-atherosclerotic arteriopathy which
usually affects small- and medium-sized cervical arteries distributed at the atlas and axis interspace. Few cervicocephalic
FMD patients are associated with multiple intracranial aneurysms which may rupture or develop. So the authors describe a cervicocephalic
FMD patient with a history of right oculomotor palsy in 2000. Angiography revealed bilateral internal carotid artery (ICA)
aneurysms and a fusiform aneurysm in right vertebral artery. Typical
Preoperative and intraoperative brain mapping for the resection of eloquent-area tumors. A prospective analysis of methodology, correlation, and usefulness based on clinical outcomes
Abstract
Background Localization of brain function is a fundamental requisite for the resection of eloquent-area brain tumors. Preoperative functional
neuroimaging and diffusion tensor imaging can display cortical functional organization and subcortical anatomy of major white
matter bundles. Direct cortical and subcortical stimulation is widely used in routine practice, however, because of its ability
to reveal tissue function in eloquent regions. The role and integration of these techniques is still a matter of debate. The
objective of this study was to assess surgical and functional neurological outputs of awake surgery and intraoperative cortical
and subcortical electrical stimulation (CSES) and to use CSES to examine the reliability of preoperative functional magnetic
resonance (fMRI) and diffusion tensor imaging fiber tracking (DTI-FT) for surgical planning.
Patients and methods We prospectively studied 27 patients with eloquent-area tumors who were selected to undergo awake surgery and direct brain
mapping. All subjects underwent preoperative sensorimotor and language fMRI and DTI tractography of major white matter bundles.
Intra- and postoperative complications, stimulation effects, extent of resection, and neurological outcome were determined.
We topographically correlated intraoperatively identified sites (cortical and subcortical) with areas of fMRI activation and
DTI tractography.
Results Total plus subtotal resection reached 88.8%. Twenty-one patients (77.7%) suffered transient postoperative worsening, but at
6 months follow-up only three (11.1%) patients had persistent neurological impairment. Sensorimotor cortex direct mapping
correlated 92.3% with fMRI activation, while direct mapping of language cortex correlated 42.8%. DTI fiber tracking underestimated
the presence of functional fibers surrounding or inside the tumor.
Conclusion Preoperative brain mapping is useful when planning awake surgery to estimate the relationship between the tumor and functional
brain regions. However, these techniques cannot directly lead the surgeon during resection. Intraoperative brain mapping is
necessary for safe and maximal resection and to guarantee a satisfying neurological outcome. This multimodal approach is more
aggressive, leads to better outcomes, and should be used routinely for resection of lesions in eloquent brain regions.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0764-9
- Authors
- Giannantonio Spena, Division of Neurosurgery, Civil Hospital, via Venezia 16, 15100 Alessandria, Italy
- Antonella Nava, Anesthesiology and Intensive Care Unit Department, Civil Hospital, Alessandria, Italy
- Fabrizio Cassini, Anesthesiology and Intensive Care Unit Department, Civil Hospital, Alessandria, Italy
- Antonio Pepoli, Division of Neurology and Neuropsychology, Civil Hospital, Alessandria, Italy
- Marcella Bruno, Division of Neurology and Neuropsychology, Civil Hospital, Alessandria, Italy
- Federico D
... / ...
Preoperative and intraoperative brain mapping for the resection of eloquent-area tumors. A prospective analysis of methodology, correlation, and usefulness based on clinical outcomes
Abstract
Background Localization of brain function is a fundamental requisite for the resection of eloquent-area brain tumors. Preoperative functional
neuroimaging and diffusion tensor imaging can display cortical functional organization and subcortical anatomy of major white
matter bundles. Direct cortical and subcortical stimulation is widely used in routine practice, however, because of its ability
to reveal tissue function in eloquent regions. The role and integration of these techniques is still a matter of debate. The
objective of this study was to assess surgical and functional neurological outputs of awake surgery and intraoperative cortical
and subcortical electrical stimulation (CSES) and to use CSES to examine the reliability of preoperative functional magnetic
resonance (fMRI) and diffusion tensor imaging fiber tracking (DTI-FT) for surgical planning.
Patients and methods We prospectively studied 27 patients with eloquent-area tumors who were selected to undergo awake surgery and direct brain
mapping. All subjects underwent preoperative sensorimotor and language fMRI and DTI tractography of major white matter bundles.
Intra- and postoperative complications, stimulation effects, extent of resection, and neurological outcome were determined.
We topographically correlated intraoperatively identified sites (cortical and subcortical) with areas of fMRI activation and
DTI tractography.
Results Total plus subtotal resection reached 88.8%. Twenty-one patients (77.7%) suffered transient postoperative worsening, but at
6 months follow-up only three (11.1%) patients had persistent neurological impairment. Sensorimotor cortex direct mapping
correlated 92.3% with fMRI activation, while direct mapping of language cortex correlated 42.8%. DTI fiber tracking underestimated
the presence of functional fibers surrounding or inside the tumor.
Conclusion Preoperative brain mapping is useful when planning awake surgery to estimate the relationship between the tumor and functional
brain regions. However, these techniques cannot directly lead the surgeon during resection. Intraoperative brain mapping is
necessary for safe and maximal resection and to guarantee a satisfying neurological outcome. This multimodal approach is more
aggressive, leads to better outcomes, and should be used routinely for resection of lesions in eloquent brain regions.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0764-9
- Authors
- Giannantonio Spena, Division of Neurosurgery, Civil Hospital, via Venezia 16, 15100 Alessandria, Italy
- Antonella Nava, Anesthesiology and Intensive Care Unit Department, Civil Hospital, Alessandria, Italy
- Fabrizio Cassini, Anesthesiology and Intensive Care Unit Department, Civil Hospital, Alessandria, Italy
- Antonio Pepoli, Division of Neurology and Neuropsychology, Civil Hospital, Alessandria, Italy
- Marcella Bruno, Division of Neurology and Neuropsychology, Civil Hospital, Alessandria, Italy
- Federico D
(21/08/2010 @ 07:46)
Spinal cord herniation: a misdiagnosed and treatable cause of thoracic myelopathy
Abstract This study is a case report and review of the literature. Spinal cord herniation is a rare, although increasingly recognized,
cause of spinal cord dysfunction. It is due to an anterior dural defect, through which the spinal cord herniates. The purpose
of this article is to report the authors ... / ...
Spinal cord herniation: a misdiagnosed and treatable cause of thoracic myelopathy
Abstract This study is a case report and review of the literature. Spinal cord herniation is a rare, although increasingly recognized,
cause of spinal cord dysfunction. It is due to an anterior dural defect, through which the spinal cord herniates. The purpose
of this article is to report the authors
Partially thrombosed intracranial aneurysms: symptoms, evolution, and therapeutic management
Abstract
Background Partially thrombosed intracranial aneurysms (PTIAs) are different from saccular or nonthrombosed giant or large aneurysms,
as they are characterized by multiple intramural thrombotic phenomena related to recurrent vessel wall dissections.
Methods We retrospectively reviewed clinical and radiological files of 23 consecutive patients with PTIAs (mean age 49.3 years). Twenty-two
lesions were studied by magnetic resonance imaging (MRI). Patients were managed by endovascular treatments, medically with
steroids, or conservatively.
Results Thirteen patients presented with progressive neurological symptoms. Subarachnoid hemorrhage was suspected but not proven in
three. At MRI, 90.9% of PTIAs caused mass effect; perilesional T2 hypersignal compatible with edema was evident in 13.6%.
Aneurysmal wall enhancement was detectable in 63.2% of the PTIAs and considered a marker of inflammatory processes. Parent
artery occlusion was performed in seven patients with clinical improvement in six. Selective coiling was proposed in three
patients (one improved, one remained stable, and one experienced symptoms progression). Three patients were treated with steroids
and improved. Ten patients were managed conservatively: eight because spontaneous thrombosis of the lesion had been diagnosed
and two because of clinical and radiological stability.
Conclusions The natural history of PTIAs is different from other aneurysms. They most commonly present with progressive neurological symptoms
due to mass effect. MRI properly diagnoses PTIAs and allows precise follow-up, more accurately than angiography because it
detects prominent ... / ...
Partially thrombosed intracranial aneurysms: symptoms, evolution, and therapeutic management
Abstract
Background Partially thrombosed intracranial aneurysms (PTIAs) are different from saccular or nonthrombosed giant or large aneurysms,
as they are characterized by multiple intramural thrombotic phenomena related to recurrent vessel wall dissections.
Methods We retrospectively reviewed clinical and radiological files of 23 consecutive patients with PTIAs (mean age 49.3 years). Twenty-two
lesions were studied by magnetic resonance imaging (MRI). Patients were managed by endovascular treatments, medically with
steroids, or conservatively.
Results Thirteen patients presented with progressive neurological symptoms. Subarachnoid hemorrhage was suspected but not proven in
three. At MRI, 90.9% of PTIAs caused mass effect; perilesional T2 hypersignal compatible with edema was evident in 13.6%.
Aneurysmal wall enhancement was detectable in 63.2% of the PTIAs and considered a marker of inflammatory processes. Parent
artery occlusion was performed in seven patients with clinical improvement in six. Selective coiling was proposed in three
patients (one improved, one remained stable, and one experienced symptoms progression). Three patients were treated with steroids
and improved. Ten patients were managed conservatively: eight because spontaneous thrombosis of the lesion had been diagnosed
and two because of clinical and radiological stability.
Conclusions The natural history of PTIAs is different from other aneurysms. They most commonly present with progressive neurological symptoms
due to mass effect. MRI properly diagnoses PTIAs and allows precise follow-up, more accurately than angiography because it
detects prominent
Comparison of electrode location between immediate postoperative day and 6 months after bilateral subthalamic nucleus deep brain stimulation
Abstract
Objective We compared the electrode positions of subthalamic nucleus (STN) deep brain stimulation (DBS) estimated at the immediate postoperative
period with those estimated 6 months after surgery.
Methods Brain CT scans were taken immediately and 6 months after bilateral STN DBS in 53 patients with Parkinson ... / ...
Comparison of electrode location between immediate postoperative day and 6 months after bilateral subthalamic nucleus deep brain stimulation
Abstract
Objective We compared the electrode positions of subthalamic nucleus (STN) deep brain stimulation (DBS) estimated at the immediate postoperative
period with those estimated 6 months after surgery.
Methods Brain CT scans were taken immediately and 6 months after bilateral STN DBS in 53 patients with Parkinson
Pros and cons of permissive hypercapnia in patients with subarachnoid haemorrhage and ARDS
Pros and cons of permissive hypercapnia in patients with subarachnoid haemorrhage and ARDS
- Content Type Journal Article
- DOI 10.1007/s00701-010-0760-0
- Authors
- Marcus H. T. Reinges, Neurosurgery, RWTH Aachen University, Pauwelstr. 30, 52057 Aachen, Germany
(17/08/2010 @ 07:52)
The intracranial volume pressure response in increased intracranial pressure patients: Part 1. Calculation of the volume pressure indicator
Abstract
Background The intracranial pressure (ICP) is usually continuously monitored in the management of patients with increased ICP. The aim
of this study was to discover a mathematic equation to express the intracranial pressure ... / ...
The intracranial volume pressure response in increased intracranial pressure patients: Part 1. Calculation of the volume pressure indicator
Abstract
Background The intracranial pressure (ICP) is usually continuously monitored in the management of patients with increased ICP. The aim
of this study was to discover a mathematic equation to express the intracranial pressure
MR imaging characteristics of oligodendroglial tumors with assessment of 1p/19q deletion status
Abstract
Purpose Patients with oligodendrogliomas with allelic loss of chromosomal arm 1p and 19q have been shown, especially with anaplastic
oligodendrogliomas, to have both a better initial and long-term response to chemotherapy as well as an improved overall survival.
Effective treatment of patients with brain tumors requires accurate diagnostic techniques. MR imaging can be used to help
differentiate between low- and high-grade tumors. We hypothesize that certain MR imaging characteristics can be used to differentiate
between patients with and without 1p and 19q deletion.
Methods Using the clinical database at the University of Virginia Neuro-Oncology Center, we identified adult patients with grade II
and III oligodendroglial tumors who underwent treatment from 2002 to 2007. Age at diagnosis, gender, tumor grade, chromosomal
deletion status, duration of follow-up, and MR imaging characteristics were analyzed; the latter was read by a blinded neuroradiologist.
Results One hundred and four patients met the inclusion criteria. Of these patients, 44 manifested 1p/19q co-deletion and 60 patients
lacked this deletion. The greatest cross-sectional area (mean) of the tumor measured 23.4 cm2 for patients with the co-deletion and 31.7 cm2 for patients with intact alleles (p ... / ...
MR imaging characteristics of oligodendroglial tumors with assessment of 1p/19q deletion status
Abstract
Purpose Patients with oligodendrogliomas with allelic loss of chromosomal arm 1p and 19q have been shown, especially with anaplastic
oligodendrogliomas, to have both a better initial and long-term response to chemotherapy as well as an improved overall survival.
Effective treatment of patients with brain tumors requires accurate diagnostic techniques. MR imaging can be used to help
differentiate between low- and high-grade tumors. We hypothesize that certain MR imaging characteristics can be used to differentiate
between patients with and without 1p and 19q deletion.
Methods Using the clinical database at the University of Virginia Neuro-Oncology Center, we identified adult patients with grade II
and III oligodendroglial tumors who underwent treatment from 2002 to 2007. Age at diagnosis, gender, tumor grade, chromosomal
deletion status, duration of follow-up, and MR imaging characteristics were analyzed; the latter was read by a blinded neuroradiologist.
Results One hundred and four patients met the inclusion criteria. Of these patients, 44 manifested 1p/19q co-deletion and 60 patients
lacked this deletion. The greatest cross-sectional area (mean) of the tumor measured 23.4 cm 2 for patients with the co-deletion and 31.7 cm 2 for patients with intact alleles ( p
Thoracic transdural spinal cord herniation at a level caudal to prior discectomy
Abstract To outline a scenario of acquired transdural spinal cord herniation not previously described. The authors report their experience
with a patient found to harbor a thoracic transdural spinal cord herniation at the disk space immediately caudal to a prior
discectomy. Documentation of the radiographic progression of this patient ... / ...
Thoracic transdural spinal cord herniation at a level caudal to prior discectomy
Abstract To outline a scenario of acquired transdural spinal cord herniation not previously described. The authors report their experience
with a patient found to harbor a thoracic transdural spinal cord herniation at the disk space immediately caudal to a prior
discectomy. Documentation of the radiographic progression of this patient
Cystic hamartoma of the tuber cinereum
Cystic hamartoma of the tuber cinereum
- Content Type Journal Article
- DOI 10.1007/s00701-010-0766-7
- Authors
- Pravin Shashikant Salunke, Department of Neurosurgery, PGIMER, Chandigarh, 160012 India
- Sukumar Sura, Department of Neurosurgery, PGIMER, Chandigarh, 160012 India
- Kirti Gupta, Department of Histopathology, PGIMER, Chandigarh, 160012 India
- Paramjeet Singh, Department of Radiodiagnosis, PGIMER, Chandigarh, 160012 India
... / ...
Cystic hamartoma of the tuber cinereum
Cystic hamartoma of the tuber cinereum
- Content Type Journal Article
- DOI 10.1007/s00701-010-0766-7
- Authors
- Pravin Shashikant Salunke, Department of Neurosurgery, PGIMER, Chandigarh, 160012 India
- Sukumar Sura, Department of Neurosurgery, PGIMER, Chandigarh, 160012 India
- Kirti Gupta, Department of Histopathology, PGIMER, Chandigarh, 160012 India
- Paramjeet Singh, Department of Radiodiagnosis, PGIMER, Chandigarh, 160012 India
(13/08/2010 @ 09:04)
The first 3 months after BCNU wafers implantation in high-grade glioma patients: clinical and radiological considerations on a clinical series
Abstract
Purpose Carmustine (1,3-bis[2-chloroetyl]-1-nitrosurea (BCNU)) wafers are approved for the local treatment of newly diagnosed and
recurrent malignant glioma. Reassuring data on both safety and efficacy of treatment have been previously reported by phase
III studies. Although most of related adverse events are reported in the first few months after surgery, there is a lack in
the literature of radiological data regarding this period. Few anecdotal experiences have been reported about surgical bed
cyst occurrence. The aim of our study is to analyse the radiological course of patients treated with wafers implantation focusing
on the relationship between radiological data, and in particular bed cyst occurrence, and safety data.
Methods Forty-three patients affected by malignant glioma underwent surgical removal and BCNU wafers implantation at the Department
of Neurosurgery of Padova from April 2007 to October 2009. Safety data were collected according to previously reported phase
III studies. Patients underwent clinical and radiological evaluation (MRI) postoperatively, then before discharge, at 1 month,
then every 2 months. In the study were included only patients whose both 1- and 3-month MRIs were available. Finally, 36 out
of 43 patients were available for the revision.
Findings Fifty-eight percent of patients treated with BCNU wafers presented a bed cyst of the surgical cave at the 1-month MRI. Forty-eight
percent of them were symptomatic. Conversely, among patients who presented one or more adverse event (27%), bed cyst was detected
in up to 90% of cases (OR 7.35), being intracranial hypertension more frequently associated (OR 7.35; p value <0.05). In general, cysts presented a benign behaviour in the sense that patients promptly improved with corticosteroid
treatment, never required surgery, never reported permanent neurological deficits.
Conclusions Surgical bed cyst occurrence in BCNU wafer-treated patients resulted more frequent than expected. Familiarity with the event
is important to correctly handle a possible evolving phenomenon. However, only further larger experiences and prospective
studies could reveal how the understanding of such event might be helpful to improve safety data.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0759-6
- Authors
- Alessandro Della Puppa, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Marta Rossetto, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Pietro Ciccarino, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Giulia Del Moro, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Antonino Rotilio, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Renzo Manara, Department of Neuro-Radiology, Padova University Hospital, Padova, Italy
- Marina Paola Gardiman, Department of Pathology, Padova University Hospital, Padova, Italy
- Luca Denaro, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Domenico d
... / ...
The first 3 months after BCNU wafers implantation in high-grade glioma patients: clinical and radiological considerations on a clinical series
Abstract
Purpose Carmustine (1,3-bis[2-chloroetyl]-1-nitrosurea (BCNU)) wafers are approved for the local treatment of newly diagnosed and
recurrent malignant glioma. Reassuring data on both safety and efficacy of treatment have been previously reported by phase
III studies. Although most of related adverse events are reported in the first few months after surgery, there is a lack in
the literature of radiological data regarding this period. Few anecdotal experiences have been reported about surgical bed
cyst occurrence. The aim of our study is to analyse the radiological course of patients treated with wafers implantation focusing
on the relationship between radiological data, and in particular bed cyst occurrence, and safety data.
Methods Forty-three patients affected by malignant glioma underwent surgical removal and BCNU wafers implantation at the Department
of Neurosurgery of Padova from April 2007 to October 2009. Safety data were collected according to previously reported phase
III studies. Patients underwent clinical and radiological evaluation (MRI) postoperatively, then before discharge, at 1 month,
then every 2 months. In the study were included only patients whose both 1- and 3-month MRIs were available. Finally, 36 out
of 43 patients were available for the revision.
Findings Fifty-eight percent of patients treated with BCNU wafers presented a bed cyst of the surgical cave at the 1-month MRI. Forty-eight
percent of them were symptomatic. Conversely, among patients who presented one or more adverse event (27%), bed cyst was detected
in up to 90% of cases (OR 7.35), being intracranial hypertension more frequently associated (OR 7.35; p value <0.05). In general, cysts presented a benign behaviour in the sense that patients promptly improved with corticosteroid
treatment, never required surgery, never reported permanent neurological deficits.
Conclusions Surgical bed cyst occurrence in BCNU wafer-treated patients resulted more frequent than expected. Familiarity with the event
is important to correctly handle a possible evolving phenomenon. However, only further larger experiences and prospective
studies could reveal how the understanding of such event might be helpful to improve safety data.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0759-6
- Authors
- Alessandro Della Puppa, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Marta Rossetto, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Pietro Ciccarino, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Giulia Del Moro, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Antonino Rotilio, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Renzo Manara, Department of Neuro-Radiology, Padova University Hospital, Padova, Italy
- Marina Paola Gardiman, Department of Pathology, Padova University Hospital, Padova, Italy
- Luca Denaro, Neurosurgery, Departement of Neurosciences, Padova University Hospital, Padova, Italy
- Domenico d
(12/08/2010 @ 08:01)
Hemostatic matrix sealant in neurosurgery: a clinical and imaging study
Abstract
Object The aim of this study was to investigate prospectively the efficacy and safety of Floseal hemostatic matrix.
Methods A total of 214 patients (87 males, 127 females; mean age 56.2 years) undergoing cranial (71.4%), craniospinal (0.9%), and
spinal (27.5%) procedures with the use of gelatin thrombin hemostatic matrix (Floseal) were included in this prospective study.
The indications for its use, surgical techniques, time to bleeding control, and associated complications were recorded.
Results Effective hemostasis, defined as cessation of bleeding, was achieved no later than 3 min after topical agent application in
all patients except in 11 cases, in which the hemostatic application was repeated. Rebleeding was disclosed in four patients
1 day after initial surgery. In one case, an intracerebral abscess developed after a malignant glioma removal. No other patient
developed allergic reactions or local or systemic complications associated with the hemostatic sealant.
Conclusion In this study, matrix hemostatic sealant helped to control operative bleeding in cranial and spinal surgery, reducing damage
to the surrounding healthy nervous tissue while shortening surgical timing. Other than safe, the immediate hemostatic effect
is an advantage in the settings of refractory bleeding.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0762-y
- Authors
- Roberto Gazzeri, Department of Neurosurgery, San Giovanni-Addolorata Hospital, Via O. Tommasini 13, 00162 Rome, Italy
- Marcelo Galarza, Department of Neurosurgery, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Massimiliano Neroni, Department of Neurosurgery, San Giovanni-Addolorata Hospital, Via O. Tommasini 13, 00162 Rome, Italy
- Alex Alfieri, Klinik und Poliklinik für Neurochirurgie, Martin-Luther Universität Halle-Wittenberg, Halle, Germany
- Marco Giordano, Department of Pathology, San Giovanni-Addolorata Hospital, Rome, Italy
... / ...
Hemostatic matrix sealant in neurosurgery: a clinical and imaging study
Abstract
Object The aim of this study was to investigate prospectively the efficacy and safety of Floseal hemostatic matrix.
Methods A total of 214 patients (87 males, 127 females; mean age 56.2 years) undergoing cranial (71.4%), craniospinal (0.9%), and
spinal (27.5%) procedures with the use of gelatin thrombin hemostatic matrix (Floseal) were included in this prospective study.
The indications for its use, surgical techniques, time to bleeding control, and associated complications were recorded.
Results Effective hemostasis, defined as cessation of bleeding, was achieved no later than 3 min after topical agent application in
all patients except in 11 cases, in which the hemostatic application was repeated. Rebleeding was disclosed in four patients
1 day after initial surgery. In one case, an intracerebral abscess developed after a malignant glioma removal. No other patient
developed allergic reactions or local or systemic complications associated with the hemostatic sealant.
Conclusion In this study, matrix hemostatic sealant helped to control operative bleeding in cranial and spinal surgery, reducing damage
to the surrounding healthy nervous tissue while shortening surgical timing. Other than safe, the immediate hemostatic effect
is an advantage in the settings of refractory bleeding.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0762-y
- Authors
- Roberto Gazzeri, Department of Neurosurgery, San Giovanni-Addolorata Hospital, Via O. Tommasini 13, 00162 Rome, Italy
- Marcelo Galarza, Department of Neurosurgery, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Massimiliano Neroni, Department of Neurosurgery, San Giovanni-Addolorata Hospital, Via O. Tommasini 13, 00162 Rome, Italy
- Alex Alfieri, Klinik und Poliklinik für Neurochirurgie, Martin-Luther Universität Halle-Wittenberg, Halle, Germany
- Marco Giordano, Department of Pathology, San Giovanni-Addolorata Hospital, Rome, Italy
(12/08/2010 @ 08:01)
The premamillary artery
Abstract
Background The microanatomical parameters of the premamillary artery (PMA) for the different configurations of the posterior communicating
artery ... / ...
The premamillary artery
Abstract
Background The microanatomical parameters of the premamillary artery (PMA) for the different configurations of the posterior communicating
artery
Spontaneous acute spinal subdural hematoma: spontaneous recovery from severe paraparesis
Abstract Spontaneous idiopathic acute spinal subdural hematomas are highly exceptional. Neurological symptoms are usually severe, and
rapid diagnosis with MRI is mandatory. Surgical evacuation has frequently been used therapeutically; however, spontaneous
recovery in mild cases has also been reported. We present a case of spontaneous recovery from severe paraparesis after spontaneous
acute SSDH, and review the English-speaking literature.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0758-7
- Authors
- Michael Payer, Neurosurgery Klinik Hirslanden, Witellikerstrasse 40, 8032 Zürich, Switzerland
- Reto Agosti, Kopfwehzentrum Hirslanden, Zürich, Switzerland
... / ...
Spontaneous acute spinal subdural hematoma: spontaneous recovery from severe paraparesis
Abstract Spontaneous idiopathic acute spinal subdural hematomas are highly exceptional. Neurological symptoms are usually severe, and
rapid diagnosis with MRI is mandatory. Surgical evacuation has frequently been used therapeutically; however, spontaneous
recovery in mild cases has also been reported. We present a case of spontaneous recovery from severe paraparesis after spontaneous
acute SSDH, and review the English-speaking literature.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0758-7
- Authors
- Michael Payer, Neurosurgery Klinik Hirslanden, Witellikerstrasse 40, 8032 Zürich, Switzerland
- Reto Agosti, Kopfwehzentrum Hirslanden, Zürich, Switzerland
(11/08/2010 @ 08:46)
The effect of lung-protective permissive hypercapnia in intracerebral pressure in patients with subarachnoid haemorrhage and ARDS. A retrospective study
Abstract
Objective Lung protective ventilation has a beneficial effect in treating patients with acute respiratory distress syndrome (ARDS).
An effect of this ventilation modality is hypercapnia, which leads to increased cerebral blood flow. Since increased cerebral
blood flow can induce brain oedema the question arises whether lung protective ventilation can be applied in patients with
subarachnoid haemorrhage.
Methods We retrospectively analysed 12 patients with subarachnoid haemorrhage who were ventilated with lung protective ventilation
since they suffered of ARDS. Tidal volume was 5 ... / ...
The effect of lung-protective permissive hypercapnia in intracerebral pressure in patients with subarachnoid haemorrhage and ARDS. A retrospective study
Abstract
Objective Lung protective ventilation has a beneficial effect in treating patients with acute respiratory distress syndrome (ARDS).
An effect of this ventilation modality is hypercapnia, which leads to increased cerebral blood flow. Since increased cerebral
blood flow can induce brain oedema the question arises whether lung protective ventilation can be applied in patients with
subarachnoid haemorrhage.
Methods We retrospectively analysed 12 patients with subarachnoid haemorrhage who were ventilated with lung protective ventilation
since they suffered of ARDS. Tidal volume was 5
Slow vasogenic fluctuations of intracranial pressure and cerebral near infrared spectroscopy
Abstract
Background/purpose Increased slow-wave activity in intracranial pressure (ICP) signifies an exhausted cerebrospinal compensatory reserve across
a range of conditions. In this study, we attempted to describe synchronisation between slow waves of ICP and of near-infrared
spectroscopy (NIRS) variables during controlled elevation of ICP.
Method Nineteen patients presenting with symptomatic hydrocephalus underwent a Computerised Infusion Test. NIRS-derived indices,
ICP and arterial blood pressure (ABP) were recorded simultaneously.
Findings ICP increased from 9.3 (6.0) ... / ...
Slow vasogenic fluctuations of intracranial pressure and cerebral near infrared spectroscopy
Abstract
Background/purpose Increased slow-wave activity in intracranial pressure (ICP) signifies an exhausted cerebrospinal compensatory reserve across
a range of conditions. In this study, we attempted to describe synchronisation between slow waves of ICP and of near-infrared
spectroscopy (NIRS) variables during controlled elevation of ICP.
Method Nineteen patients presenting with symptomatic hydrocephalus underwent a Computerised Infusion Test. NIRS-derived indices,
ICP and arterial blood pressure (ABP) were recorded simultaneously.
Findings ICP increased from 9.3 (6.0)
Training in endoscopic endonasal transsphenoidal surgery using a skull model and eggs
Abstract
Background Recently, endoscopic pituitary surgery is increasingly being used in pituitary surgery. Compared to conventional microscopic
pituitary surgery, outcomes have been non-inferior, so endoscopic pituitary surgery has become an established surgical technique.
However, this is a highly specialized surgery and sophisticated surgical techniques are required. We report our development
of a training model for endoscopic endonasal transsphenoidal surgery.
Methods Our training model is constructed using a skull model and eggs. The sella turcica of the skull model is hollowed out and an
egg is placed. The bottom of the egg simulates the sella turcica floor and the egg contents simulate a tumor. Training is
conducted using this model in an actual operating room with actual surgical instruments.
Results This model is highly realistic and is within acceptable limits as a surgical simulation. Since practice can be repeated, this
model is effective for familiarization with endoscopic imaging and to increase technical skills such as drilling and curetting.
In addition, variations in eggs, ranging from raw eggs to boiled eggs, can be used to simulate various tumors for training.
Conclusions This training model using a skull model and eggs is useful to improve surgical techniques in endoscopic endonasal transsphenoidal
surgery.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0728-0
- Authors
- Takeshi Okuda, Department of Neurosurgery, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511 Japan
- Kazuo Kataoka, Department of Neurosurgery, Nara Hospital, Kinki University School of Medicine, Nara, Japan
- Amami Kato, Department of Neurosurgery, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511 Japan
... / ...
Training in endoscopic endonasal transsphenoidal surgery using a skull model and eggs
Abstract
Background Recently, endoscopic pituitary surgery is increasingly being used in pituitary surgery. Compared to conventional microscopic
pituitary surgery, outcomes have been non-inferior, so endoscopic pituitary surgery has become an established surgical technique.
However, this is a highly specialized surgery and sophisticated surgical techniques are required. We report our development
of a training model for endoscopic endonasal transsphenoidal surgery.
Methods Our training model is constructed using a skull model and eggs. The sella turcica of the skull model is hollowed out and an
egg is placed. The bottom of the egg simulates the sella turcica floor and the egg contents simulate a tumor. Training is
conducted using this model in an actual operating room with actual surgical instruments.
Results This model is highly realistic and is within acceptable limits as a surgical simulation. Since practice can be repeated, this
model is effective for familiarization with endoscopic imaging and to increase technical skills such as drilling and curetting.
In addition, variations in eggs, ranging from raw eggs to boiled eggs, can be used to simulate various tumors for training.
Conclusions This training model using a skull model and eggs is useful to improve surgical techniques in endoscopic endonasal transsphenoidal
surgery.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0728-0
- Authors
- Takeshi Okuda, Department of Neurosurgery, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511 Japan
- Kazuo Kataoka, Department of Neurosurgery, Nara Hospital, Kinki University School of Medicine, Nara, Japan
- Amami Kato, Department of Neurosurgery, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511 Japan
(11/08/2010 @ 08:46)
Secondary insults following traumatic brain injury enhance complement activation in the human brain and release of the tissue damage marker S100B
Abstract
Object Complement activation has been suggested to play a role in the development of secondary injuries following traumatic brain
injury (TBI). The present study was initiated in order to analyze complement activation in relation to the primary brain injury
and to secondary insults, frequently occurring following TBI.
Methods Twenty patients suffering from severe TBI (Glasgow coma score ... / ...
Secondary insults following traumatic brain injury enhance complement activation in the human brain and release of the tissue damage marker S100B
Abstract
Object Complement activation has been suggested to play a role in the development of secondary injuries following traumatic brain
injury (TBI). The present study was initiated in order to analyze complement activation in relation to the primary brain injury
and to secondary insults, frequently occurring following TBI.
Methods Twenty patients suffering from severe TBI (Glasgow coma score
Primary yolk sac tumor of the paracavernous region
Primary yolk sac tumor of the paracavernous region
- Content Type Journal Article
- DOI 10.1007/s00701-010-0757-8
- Authors
- Neelima Radhakrishnan, Medical College PO Department of Pathology, Sree Chitra Tirunal Institute of Medical Sciences and Technology Trivandrum Kerala India
- Ravi Mohan Rao, Sree Chitra Tirunal Institute of Medical Sciences and Technology Department of Neurosurgery Trivandrum Kerala India
- T. R. Kapilamoorthy, Sree Chitra Tirunal Institute of Medical Sciences and Technology Department of Imaging Sciences and Interventional Radiology Trivandrum Kerala India
- V. V. Radhakrishnan, Medical College PO Department of Pathology, Sree Chitra Tirunal Institute of Medical Sciences and Technology Trivandrum Kerala India
... / ...
Primary yolk sac tumor of the paracavernous region
Primary yolk sac tumor of the paracavernous region
- Content Type Journal Article
- DOI 10.1007/s00701-010-0757-8
- Authors
- Neelima Radhakrishnan, Medical College PO Department of Pathology, Sree Chitra Tirunal Institute of Medical Sciences and Technology Trivandrum Kerala India
- Ravi Mohan Rao, Sree Chitra Tirunal Institute of Medical Sciences and Technology Department of Neurosurgery Trivandrum Kerala India
- T. R. Kapilamoorthy, Sree Chitra Tirunal Institute of Medical Sciences and Technology Department of Imaging Sciences and Interventional Radiology Trivandrum Kerala India
- V. V. Radhakrishnan, Medical College PO Department of Pathology, Sree Chitra Tirunal Institute of Medical Sciences and Technology Trivandrum Kerala India
(05/08/2010 @ 15:25)
Time course of heme oxygenase-1 and oxidative stress after experimental intracerebral hemorrhage
Abstract
Background Heme oxygenase-1 (HO-1), the rate-limiting enzyme for heme catabolism and iron production, its role in intracerebral hemorrhage
(ICH) is controversial. The study was to investigate correlations between brain oxidative injury and HO-1 after experimental
ICH.
Time course of heme oxygenase-1 and oxidative stress after experimental intracerebral hemorrhage
Abstract
Background Heme oxygenase-1 (HO-1), the rate-limiting enzyme for heme catabolism and iron production, its role in intracerebral hemorrhage
(ICH) is controversial. The study was to investigate correlations between brain oxidative injury and HO-1 after experimental
ICH.
Method Sprague
Hyponatremia is predictable in patients with aneurysmal subarachnoid hemorrhage
Abstract
Purpose Serum atrial natriuretic peptide (ANP) that is elevated after aneurysmal subarachnoid hemorrhage (SAH) causes diuresis and
natriuresis (cerebral salt wasting) and might exacerbate delayed ischemic neurological deficit (DIND). We investigated relationships
among hyponatremia, serum ANP elevation, and the onset of DIND after SAH.
Materials and methods Thirty-nine consecutive patients (15 women and 24 men) with SAH were assigned to a normonatremia group or a group that developed
hyponatremia after SAH. Serum ANP and brain natriuretic peptide were assessed after SAH. All patients remained normovolemic
and normotensive. We attributed DIND to vasospasm only in the absence of other causes and when supported by cerebral angiography.
Results Hyponatremia developed after SAH in 11 patients (28.2%), among whom serum ANP concentrations at 0 and 3 days thereafter were
significantly increased. Furthermore, DIND developed in five (45.5%) and two (7.1%) hyponatremic and normonatremic patients,
respectively (P ... / ...
Hyponatremia is predictable in patients with aneurysmal subarachnoid hemorrhage
Abstract
Purpose Serum atrial natriuretic peptide (ANP) that is elevated after aneurysmal subarachnoid hemorrhage (SAH) causes diuresis and
natriuresis (cerebral salt wasting) and might exacerbate delayed ischemic neurological deficit (DIND). We investigated relationships
among hyponatremia, serum ANP elevation, and the onset of DIND after SAH.
Materials and methods Thirty-nine consecutive patients (15 women and 24 men) with SAH were assigned to a normonatremia group or a group that developed
hyponatremia after SAH. Serum ANP and brain natriuretic peptide were assessed after SAH. All patients remained normovolemic
and normotensive. We attributed DIND to vasospasm only in the absence of other causes and when supported by cerebral angiography.
Results Hyponatremia developed after SAH in 11 patients (28.2%), among whom serum ANP concentrations at 0 and 3 days thereafter were
significantly increased. Furthermore, DIND developed in five (45.5%) and two (7.1%) hyponatremic and normonatremic patients,
respectively ( P
Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre
Abstract
Background Previously, we reported on our single centre results regarding the diagnostic yield of stereotactic needle biopsies of brain
lesions. The yield then (1996 ... / ...
Towards improving the safety and diagnostic yield of stereotactic biopsy in a single centre
Abstract
Background Previously, we reported on our single centre results regarding the diagnostic yield of stereotactic needle biopsies of brain
lesions. The yield then (1996
Preserved cognition after deep brain stimulation (DBS) in the subthalamic area for Parkinson's disease: a case report
Abstract At present, subthalamic nucleus (STN) stimulation is the preferred procedure for the amelioration of motor symptoms in medication
refractory Parkinson's disease. Results are however impaired by negative impacts on mood, cognition, incentive, and social
judgment. Alternative targets are therefore explored. We describe a case with stimulation of subthalamic fibre tracts that
showed clear improvement of cognitive and social abilities. Avoiding the STN may be advantageous in progressive Parkinson's
disease to avoid non-motor complications and enhance quality of life.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0755-x
- Authors
- Donatus Cyron, Department of Neurosurgery, Klinik Hirslanden Witellikerstrasse 40 CH-8032 Zürich Switzerland
- Marion Funk, Kopfwehzentrum Hirslanden Zürich Forchstrasse 424 CH-8702 Zollikon Switzerland
- Marie-An Deletter, Arztpraxis Dr. med. Jürg Jäger Erachfeldstrasse 2 8180 Bülach ZH Switzerland
- Kai Scheufler, Department of Neurosurgery, Klinik Hirslanden Witellikerstrasse 40 CH-8032 Zürich Switzerland
... / ...
Preserved cognition after deep brain stimulation (DBS) in the subthalamic area for Parkinson's disease: a case report
Abstract At present, subthalamic nucleus (STN) stimulation is the preferred procedure for the amelioration of motor symptoms in medication
refractory Parkinson's disease. Results are however impaired by negative impacts on mood, cognition, incentive, and social
judgment. Alternative targets are therefore explored. We describe a case with stimulation of subthalamic fibre tracts that
showed clear improvement of cognitive and social abilities. Avoiding the STN may be advantageous in progressive Parkinson's
disease to avoid non-motor complications and enhance quality of life.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0755-x
- Authors
- Donatus Cyron, Department of Neurosurgery, Klinik Hirslanden Witellikerstrasse 40 CH-8032 Zürich Switzerland
- Marion Funk, Kopfwehzentrum Hirslanden Zürich Forchstrasse 424 CH-8702 Zollikon Switzerland
- Marie-An Deletter, Arztpraxis Dr. med. Jürg Jäger Erachfeldstrasse 2 8180 Bülach ZH Switzerland
- Kai Scheufler, Department of Neurosurgery, Klinik Hirslanden Witellikerstrasse 40 CH-8032 Zürich Switzerland
(30/07/2010 @ 18:57)
Primary carcinoid tumor of the filum terminale
Abstract Carcinoid tumors with a primary site in the central nervous system have not been reported in literature yet. We report here
about a 41-year-old patient with recurrent and progressive low back pain and bilateral S1 radiculopathy on admission. The
patient underwent hemi-laminectomies of the vertebral bodies L5 and S1 and an en bloc resection of the tumor. Postoperative
histopathological examination resulted in a well-differentiated intrathecal neuroendocrine tumor (carcinoid) of the terminal
filum. Postoperative staging showed no pathological abnormalities and no tumor recurrence after 6 months. Even though rare,
carcinoids should be considered as differential diagnosis of tumors occurring in the CNS.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0756-9
- Authors
- Amr Abdulazim, BG-University Hospital Bergmannsheil Division of Spinal Cord Injury Bürkle-de-la-Camp-Platz 1 44789 Bochum Germany
- Mustafa Citak, BG-University Hospital Bergmannsheil Department of Surgery Bochum Germany
- Manuel Backhaus, BG-University Hospital Bergmannsheil Department of Surgery Bochum Germany
- Martin N. Stienen, BG-University Hospital Bergmannsheil Division of Spinal Cord Injury Bürkle-de-la-Camp-Platz 1 44789 Bochum Germany
- Christoph Horch, BG-University Hospital Bergmannsheil Division of Spinal Cord Injury Bürkle-de-la-Camp-Platz 1 44789 Bochum Germany
... / ...
Primary carcinoid tumor of the filum terminale
Abstract Carcinoid tumors with a primary site in the central nervous system have not been reported in literature yet. We report here
about a 41-year-old patient with recurrent and progressive low back pain and bilateral S1 radiculopathy on admission. The
patient underwent hemi-laminectomies of the vertebral bodies L5 and S1 and an en bloc resection of the tumor. Postoperative
histopathological examination resulted in a well-differentiated intrathecal neuroendocrine tumor (carcinoid) of the terminal
filum. Postoperative staging showed no pathological abnormalities and no tumor recurrence after 6 months. Even though rare,
carcinoids should be considered as differential diagnosis of tumors occurring in the CNS.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0756-9
- Authors
- Amr Abdulazim, BG-University Hospital Bergmannsheil Division of Spinal Cord Injury Bürkle-de-la-Camp-Platz 1 44789 Bochum Germany
- Mustafa Citak, BG-University Hospital Bergmannsheil Department of Surgery Bochum Germany
- Manuel Backhaus, BG-University Hospital Bergmannsheil Department of Surgery Bochum Germany
- Martin N. Stienen, BG-University Hospital Bergmannsheil Division of Spinal Cord Injury Bürkle-de-la-Camp-Platz 1 44789 Bochum Germany
- Christoph Horch, BG-University Hospital Bergmannsheil Division of Spinal Cord Injury Bürkle-de-la-Camp-Platz 1 44789 Bochum Germany
(30/07/2010 @ 18:57)
Preysyrinx state and shunt dysfunction: an under recognized entity?
Abstract Presyrinx state is a relatively recently recognized condition. Prompt identification of this condition and appropriate treatment
leads to reversal of the radiological and clinical findings with a good prognosis. Failure to identify this condition in a
timely fashion leads to fully established syringomyelia. To date, presyrinx state has not been described as a feature of shunt
dysfunction. One such rare case is being reported. A 14-year-old boy who was shunted for postmeningitic hydrocephalus at the
age of 2 years and subsequently underwent shunt revision presented for routine follow-up and was found to have shunt dysfunction.
CT scan showed panventriculomegaly and MRI studies showed panventriculomegaly with a ... / ...
Preysyrinx state and shunt dysfunction: an under recognized entity?
Abstract Presyrinx state is a relatively recently recognized condition. Prompt identification of this condition and appropriate treatment
leads to reversal of the radiological and clinical findings with a good prognosis. Failure to identify this condition in a
timely fashion leads to fully established syringomyelia. To date, presyrinx state has not been described as a feature of shunt
dysfunction. One such rare case is being reported. A 14-year-old boy who was shunted for postmeningitic hydrocephalus at the
age of 2 years and subsequently underwent shunt revision presented for routine follow-up and was found to have shunt dysfunction.
CT scan showed panventriculomegaly and MRI studies showed panventriculomegaly with a
Post-traumatic peripheral facial nerve palsy: surgical and neuroradiological consideration in five cases of delayed onset
Abstract The facial nerve is frequently injured after head trauma with or without temporal bone fractures. Computed tomography (CT)
is the best procedure for detecting the fracture line at the level of the facial nerve canal and for assessing any associated
lesions within the temporal bone. Magnetic resonance (MR) is required if there is a facial nerve paralysis, unexplained by
CT findings. We present five cases of delayed post-traumatic facial nerve palsy without evidence of temporal bone fractures
on CT, thus studied on MR. MR was essential for diagnosing the nerve impairment. Neuroradiological findings, clinical presentation,
and electrodiagnostic tests influenced the management of the patients.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0747-x
- Authors
- Michele Rotondo, Second University of Naples, CTO Hospital Department of Neurological Sciences Viale Colli Aminei, 21 80135 Naples Italy
- Raffaele D
... / ...
Post-traumatic peripheral facial nerve palsy: surgical and neuroradiological consideration in five cases of delayed onset
Abstract The facial nerve is frequently injured after head trauma with or without temporal bone fractures. Computed tomography (CT)
is the best procedure for detecting the fracture line at the level of the facial nerve canal and for assessing any associated
lesions within the temporal bone. Magnetic resonance (MR) is required if there is a facial nerve paralysis, unexplained by
CT findings. We present five cases of delayed post-traumatic facial nerve palsy without evidence of temporal bone fractures
on CT, thus studied on MR. MR was essential for diagnosing the nerve impairment. Neuroradiological findings, clinical presentation,
and electrodiagnostic tests influenced the management of the patients.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0747-x
- Authors
- Michele Rotondo, Second University of Naples, CTO Hospital Department of Neurological Sciences Viale Colli Aminei, 21 80135 Naples Italy
- Raffaele D
(27/07/2010 @ 00:11)
Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature
Abstract
Purpose Deep brain stimulation (DBS) has been established as a safe and efficient method for the treatment of various movement disorders.
As the emerging applications continue to expand and more centers become eligible for the procedure, complication rates and
complication avoidance become increasingly important. Our aim was to report the DBS-related complication in our department
over the last 7 years, compare our rates with those reported in the literature, and highlight those practices that will aid
complications avoidance.
Patients and methods Since 2003, 106 patients underwent DBS for various pathologies in our department. There were 38 (36%) females and 68 (64%)
males with a mean age of 57 years. Preoperative diagnoses included Parkinson ... / ...
Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature
Abstract
Purpose Deep brain stimulation (DBS) has been established as a safe and efficient method for the treatment of various movement disorders.
As the emerging applications continue to expand and more centers become eligible for the procedure, complication rates and
complication avoidance become increasingly important. Our aim was to report the DBS-related complication in our department
over the last 7 years, compare our rates with those reported in the literature, and highlight those practices that will aid
complications avoidance.
Patients and methods Since 2003, 106 patients underwent DBS for various pathologies in our department. There were 38 (36%) females and 68 (64%)
males with a mean age of 57 years. Preoperative diagnoses included Parkinson
A role of diffusion tensor imaging in movement disorder surgery
Abstract The safe and reversible nature of deep brain stimulation (DBS) has allowed movement disorder neurosurgery to become commonplace
throughout the world. Fundamental understanding of individual patient ... / ...
A role of diffusion tensor imaging in movement disorder surgery
Abstract The safe and reversible nature of deep brain stimulation (DBS) has allowed movement disorder neurosurgery to become commonplace
throughout the world. Fundamental understanding of individual patient
Ultrasound-guided operations in unselected high-grade gliomas
Abstract
Background A number of tools, including intraoperative ultrasound, are reported to facilitate surgical resection of high-grade gliomas.
However, results from selected surgical series do not necessarily reflect the effectiveness in common neurosurgical practice.
Delineation of seemingly similar brain tumours vary in different ultrasound-guided operations, perhaps limiting usefulness
in certain patients.
Methods We explore and describe the results associated with use of the SonoWand system with intraoperative ultrasound in a population-based,
unselected, high-grade glioma series. Surgeons filled out questionnaires about presumed extent of resection, use of ultrasound
and ultrasound image quality just after surgery. We evaluate the impact of ultrasound image quality. We also explore the importance
of patient selection for surgical results.
Results Of 156 consecutive malignant glioma operations, 142 (91%) were resections whilst 14 (9%) were only biopsies. We achieved gross
total resection (GTR) in 37% of all high-grade glioma resections, whilst worsening of functional status was seen in 13%. The
risk of getting worse was significantly higher in reoperations, resections in eloquent locations, resections in cases with
poor ultrasound image quality, resection when surgeons ... / ...
Ultrasound-guided operations in unselected high-grade gliomas
Abstract
Background A number of tools, including intraoperative ultrasound, are reported to facilitate surgical resection of high-grade gliomas.
However, results from selected surgical series do not necessarily reflect the effectiveness in common neurosurgical practice.
Delineation of seemingly similar brain tumours vary in different ultrasound-guided operations, perhaps limiting usefulness
in certain patients.
Methods We explore and describe the results associated with use of the SonoWand system with intraoperative ultrasound in a population-based,
unselected, high-grade glioma series. Surgeons filled out questionnaires about presumed extent of resection, use of ultrasound
and ultrasound image quality just after surgery. We evaluate the impact of ultrasound image quality. We also explore the importance
of patient selection for surgical results.
Results Of 156 consecutive malignant glioma operations, 142 (91%) were resections whilst 14 (9%) were only biopsies. We achieved gross
total resection (GTR) in 37% of all high-grade glioma resections, whilst worsening of functional status was seen in 13%. The
risk of getting worse was significantly higher in reoperations, resections in eloquent locations, resections in cases with
poor ultrasound image quality, resection when surgeons
Bilateral abducent nerve palsy as the initial clinical manifestation of medulloblastoma
Bilateral abducent nerve palsy as the initial clinical manifestation of medulloblastoma
- Content Type Journal Article
- DOI 10.1007/s00701-010-0751-1
- Authors
- Sachin Baldawa, Sree Chitra Tirunal Institute for Medical Sciences and Technology Department of Neurosurgery Trivandrum 695011 India
- C. V. Gopalakrishnan, Sree Chitra Tirunal Institute for Medical Sciences and Technology Department of Neurosurgery Trivandrum 695011 India
... / ...
Bilateral abducent nerve palsy as the initial clinical manifestation of medulloblastoma
Bilateral abducent nerve palsy as the initial clinical manifestation of medulloblastoma
- Content Type Journal Article
- DOI 10.1007/s00701-010-0751-1
- Authors
- Sachin Baldawa, Sree Chitra Tirunal Institute for Medical Sciences and Technology Department of Neurosurgery Trivandrum 695011 India
- C. V. Gopalakrishnan, Sree Chitra Tirunal Institute for Medical Sciences and Technology Department of Neurosurgery Trivandrum 695011 India
(23/07/2010 @ 13:06)
Bone morphogenetic protein-2 expression in spinal fusion masses enhanced by extracorporeal shock wave treatment: a rabbit experiment
Abstract
Purpose Extracorporeal shock wave (ESW) has been introduced to enhance spinal fusion. This study was conducted to assess the effect
of ESW on bone morphogenetic protein-2 (BMP-2) expression in a spinal fusion experiment.
Methods Twelve rabbits underwent fusion at bilateral L5 ... / ...
Bone morphogenetic protein-2 expression in spinal fusion masses enhanced by extracorporeal shock wave treatment: a rabbit experiment
Abstract
Purpose Extracorporeal shock wave (ESW) has been introduced to enhance spinal fusion. This study was conducted to assess the effect
of ESW on bone morphogenetic protein-2 (BMP-2) expression in a spinal fusion experiment.
Methods Twelve rabbits underwent fusion at bilateral L5
Virtual reality presurgical planning for cerebral gliomas adjacent to motor pathways in an integrated 3-D stereoscopic visualization of structural MRI and DTI tractography
Abstract
Objective Resection of gliomas invading primary motor cortex and subcortical motor pathway is difficult in both surgical decision-making
and functional outcome prediction. In this study, magnetic resonance (MR) diffusion tensor imaging (DTI) data were used to
perform tractography to visualize pyramidal tract (PT) along its whole length in a stereoscopic virtual reality (VR) environment.
The potential value of its clinical application was evaluated.
Methods Both three-dimensional (3-D) magnetic resonance imaging (MRI) and DTI datasets were obtained from 45 eligible patients with
suspected cerebral gliomas and then transferred to the VR system (Dextroscope; Volume Interactions Pte. Ltd., Singapore).
The cortex and tumor were segmented and reconstructed via MRI, respectively, while the tractographic PTs were reconstructed
via DTI. All those were presented in a stereoscopic 3-D display synchronously, for the purpose of patient-specific presurgical
planning and surgical simulation in each case. The relationship between increasing amplitude of the number of effective fibers
of PT (EPT) at affected sides and the patients ... / ...
Virtual reality presurgical planning for cerebral gliomas adjacent to motor pathways in an integrated 3-D stereoscopic visualization of structural MRI and DTI tractography
Abstract
Objective Resection of gliomas invading primary motor cortex and subcortical motor pathway is difficult in both surgical decision-making
and functional outcome prediction. In this study, magnetic resonance (MR) diffusion tensor imaging (DTI) data were used to
perform tractography to visualize pyramidal tract (PT) along its whole length in a stereoscopic virtual reality (VR) environment.
The potential value of its clinical application was evaluated.
Methods Both three-dimensional (3-D) magnetic resonance imaging (MRI) and DTI datasets were obtained from 45 eligible patients with
suspected cerebral gliomas and then transferred to the VR system (Dextroscope; Volume Interactions Pte. Ltd., Singapore).
The cortex and tumor were segmented and reconstructed via MRI, respectively, while the tractographic PTs were reconstructed
via DTI. All those were presented in a stereoscopic 3-D display synchronously, for the purpose of patient-specific presurgical
planning and surgical simulation in each case. The relationship between increasing amplitude of the number of effective fibers
of PT (EPT) at affected sides and the patients
Postoperative MRI examinations in patients treated by deep brain stimulation using a non-standard protocol
Abstract
Background MRI in patients bearing deep brain stimulation (DBS) electrodes may induce cerebral lesions due to electrode heating. To avoid
neurological deficits related to MRI, post-operative MRI protocol was installed in our institution. However, our protocol
comprised a higher specific absorption rate (SAR) and different positioning of lead excess than the later released electrode
manufacturer's guidelines. The objective was to evaluate the safety using this protocol.
Methods Between January 2000 and May 2008, post-operative MRI was performed in all patients. In selected patients, additional MRI
scans were performed with the implanted generator. MRI was acquired at 1.5 T with a RF transmit/receive head coil comprising
a T2-weighted fast spin echo (FSE) and a T1-weighted inversion recovery FSE sequence. Local cranial SAR values measured up
to 0.9 W/kg compared to the manufacturer's recommendation of 0.1 W/kg. Initial scans (1 ... / ...
Postoperative MRI examinations in patients treated by deep brain stimulation using a non-standard protocol
Abstract
Background MRI in patients bearing deep brain stimulation (DBS) electrodes may induce cerebral lesions due to electrode heating. To avoid
neurological deficits related to MRI, post-operative MRI protocol was installed in our institution. However, our protocol
comprised a higher specific absorption rate (SAR) and different positioning of lead excess than the later released electrode
manufacturer's guidelines. The objective was to evaluate the safety using this protocol.
Methods Between January 2000 and May 2008, post-operative MRI was performed in all patients. In selected patients, additional MRI
scans were performed with the implanted generator. MRI was acquired at 1.5 T with a RF transmit/receive head coil comprising
a T2-weighted fast spin echo (FSE) and a T1-weighted inversion recovery FSE sequence. Local cranial SAR values measured up
to 0.9 W/kg compared to the manufacturer's recommendation of 0.1 W/kg. Initial scans (1
What is the purpose of statistical modelling in traumatic brain injury?
What is the purpose of statistical modelling in traumatic brain injury?
- Content Type Journal Article
- DOI 10.1007/s00701-010-0746-y
- Authors
- Adel Helmy, University of Cambridge Department of Clinical Neurosciences Box 167 Addenbrooke
(19/07/2010 @ 19:45)
Apical temporal lobe resection;
Abstract
Background It is the aim of epilepsy surgery in patients with lesional epilepsy for the surgeon to not only remove the lesion itself,
but also the epileptogenic zone. Here, we report our experience with a modified temporal resection technique confined to the
apical temporal lobe, i.e., sparing the hippocampal formation in patients with epileptogenic lesions in the anterior part
of the temporal lobe. This apical temporal lobe resection (aTLR) includes tailored lesionectomy, amygdalectomy, and resection
of the mesial structures only in the apex of the temporal lobe. This paper presents our surgical technical details and the
outcome of aTLR.
Methods Between 2001 and 2008, aTLR was performed in 61 patients. All patients underwent comprehensive presurgical evaluation including
video-EEG monitoring, magnetic resonance imaging (MRI), and neuropsychological testing. All patients had a lesion in the apex
of the temporal lobe and a normal hippocampus as seen in MRI, as well as intact memory functions in neuropsychological examination.
There were 33 males (54.1%) and 28 females (45.9%). The mean age in years at epilepsy onset was 20.2 ... / ...
Apical temporal lobe resection;
Abstract
Background It is the aim of epilepsy surgery in patients with lesional epilepsy for the surgeon to not only remove the lesion itself,
but also the epileptogenic zone. Here, we report our experience with a modified temporal resection technique confined to the
apical temporal lobe, i.e., sparing the hippocampal formation in patients with epileptogenic lesions in the anterior part
of the temporal lobe. This apical temporal lobe resection (aTLR) includes tailored lesionectomy, amygdalectomy, and resection
of the mesial structures only in the apex of the temporal lobe. This paper presents our surgical technical details and the
outcome of aTLR.
Methods Between 2001 and 2008, aTLR was performed in 61 patients. All patients underwent comprehensive presurgical evaluation including
video-EEG monitoring, magnetic resonance imaging (MRI), and neuropsychological testing. All patients had a lesion in the apex
of the temporal lobe and a normal hippocampus as seen in MRI, as well as intact memory functions in neuropsychological examination.
There were 33 males (54.1%) and 28 females (45.9%). The mean age in years at epilepsy onset was 20.2
(16/07/2010 @ 20:18)
Tentorial dural fistula with giant venous ampulae treated with embolisation and surgery. A case report
Abstract Tentorial dural arteriovenous fistulas are rare and complex lesions in deep locations with unusual vascular anatomy and critical
surrounding neuroanatomy. A rare case presenting a complex fistula with a giant venous draining ampulae, causing headaches
and visual troubles is presented. We describe the case of a 52-year-old woman admitted in our department for headaches and
visual troubles. Magnetic resonance imaging and cerebral angiography showed a tentorial dural arteriovenous fistula draining
in a giant tentorial venous ampulae and leptomeningeal veins. The patient was embolised via an arterial route with a good
clinical and radiological result. However, 4 days later she presented a sudden change of her clinical status with coma, left
hemiparesis and a right midriasis. The cerebral computed tomography scan showed a huge occipital haemorrhagic mass and a severe cerebral oedema. An emergent surgical procedure was decided realising
evacuation of the occipital haematoma and a complete resection of the giant venous ampoule. The neck of the ampulae was sutured
and clipped at its dural entrance. Postoperatively a new embolisation was realised because of persistent of a small dural
fistulae with occipital leptomeningeal drainage. The patient recovered rapidly with only a residual hemianopsy. Treatment of dural AV malformation represent a serious challenge.
Our report describes an unusual case of a tentorial dural complex fistula treated by an endovascular procedure with secondary
clinical aggravation that needed emergent surgical therapy. Even in a case for good immediate radiological result after endovascular
procedure, dural arteriovenous fistulas with giant venous ampulae and important venous engorgement, need closed follow-up,
because of the possibility of aggravation secondary to venous thrombosis and haemorrhage. Treatment and patophysiology of
the aggravation mechanism are discussed.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0722-6
- Authors
- Alin Borha, University Hospital, CHU Caen Neurosurgical Department Caen France
- Evelyne Emery, University Hospital, CHU Caen Neurosurgical Department Caen France
- Patrick Courtheoux, University Hospital, CHU Caen Neuroradiological Department Caen France
- Pascal Lefevre, University Hospital, CHU Caen Neurosurgical Department Caen France
- Jean Michel Derlon, University Hospital, CHU Caen Neurosurgical Department Caen France
... / ...
Tentorial dural fistula with giant venous ampulae treated with embolisation and surgery. A case report
Abstract Tentorial dural arteriovenous fistulas are rare and complex lesions in deep locations with unusual vascular anatomy and critical
surrounding neuroanatomy. A rare case presenting a complex fistula with a giant venous draining ampulae, causing headaches
and visual troubles is presented. We describe the case of a 52-year-old woman admitted in our department for headaches and
visual troubles. Magnetic resonance imaging and cerebral angiography showed a tentorial dural arteriovenous fistula draining
in a giant tentorial venous ampulae and leptomeningeal veins. The patient was embolised via an arterial route with a good
clinical and radiological result. However, 4 days later she presented a sudden change of her clinical status with coma, left
hemiparesis and a right midriasis. The cerebral computed tomography scan showed a huge occipital haemorrhagic mass and a severe cerebral oedema. An emergent surgical procedure was decided realising
evacuation of the occipital haematoma and a complete resection of the giant venous ampoule. The neck of the ampulae was sutured
and clipped at its dural entrance. Postoperatively a new embolisation was realised because of persistent of a small dural
fistulae with occipital leptomeningeal drainage. The patient recovered rapidly with only a residual hemianopsy. Treatment of dural AV malformation represent a serious challenge.
Our report describes an unusual case of a tentorial dural complex fistula treated by an endovascular procedure with secondary
clinical aggravation that needed emergent surgical therapy. Even in a case for good immediate radiological result after endovascular
procedure, dural arteriovenous fistulas with giant venous ampulae and important venous engorgement, need closed follow-up,
because of the possibility of aggravation secondary to venous thrombosis and haemorrhage. Treatment and patophysiology of
the aggravation mechanism are discussed.
- Content Type Journal Article
- DOI 10.1007/s00701-010-0722-6
- Authors
- Alin Borha, University Hospital, CHU Caen Neurosurgical Department Caen France
- Evelyne Emery, University Hospital, CHU Caen Neurosurgical Department Caen France
- Patrick Courtheoux, University Hospital, CHU Caen Neuroradiological Department Caen France
- Pascal Lefevre, University Hospital, CHU Caen Neurosurgical Department Caen France
- Jean Michel Derlon, University Hospital, CHU Caen Neurosurgical Department Caen France
(16/07/2010 @ 09:19)
Dernière mise à jour : 08/09/2010 @ 19:41 |
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