1,720,984 research outputs found
Resection of supratentorial gliomas: the need to merge microsurgical technical cornerstones with modern functional mapping concepts. An overview
No full textAlthough surgery is not curative for the majority of intracranial gliomas, radical resection has been demonstrated to influence survival and delay tumor progression. Because gliomas are very frequently located in eloquent or more generally critical areas, surgeons must always balance the maximizing resection with the need to preserve neurological function. In this overview, we tried to summarize the recent literature and our personal experience about (1) the benefits and limits of using preoperative anatomical and functional neuroimaging (anatomical MRI, DTI fiber tracking, and functional MRI), (2) the issues to consider in planning the surgical strategy, (3) the need to thoroughly understand microsurgical techniques that enable a maximal resection (subpial dissection, vascular manipulation, etc.), (4) the importance of individualizing surgical strategy especially in patients with gliomas in eloquent areas (the role of neuropsychological evaluation in redefining eloquent and non-eloquent areas), and (5) how to use intraoperative mapping techniques and understand why and when to use them. Through this paper, the reader should become more familiar with a comprehensive panel of techniques and methodologies but more importantly become aware that these recent technical advances facilitate a conceptual change from classical surgical paradigms toward a more patient-specific approach
Minimally invasive surgery for thoracic and lumbar spinal fractures: rationale for treatment
No full text
Central neuropathic itch as the presenting symptom of an intramedullary cavernous hemangioma: Case report and review of literature.
No full textComputerized gait analysis with inertial sensor in the management of idiopathic normal pressure hydrocephalus
No full textBackground: Gait disturbance (GD) is usually the first and most prominent symptom observed in idiopathic normal pressure hydrocephalus (iNPH). The reversibility of symptoms is related to early diagnosis and treatment. Nowadays early recognition of patients is challenging because GD in the elderly is frequently neglected, leading to late diagnosis and increased disability. In addition, GD is generally assessed by clinical evaluation since computerized gait analysis methods are rarely available. In the present study, we demonstrate the clinical application of an inertial sensor system for gait analysis in iNPH. Aim: The primary aim was to test the sensor performance in quantifying impairment in gait parameters in iNPH. The secondary aim was to detect a range of improvement after CSF subtraction test, which could be considered as predictive of favorable shunt response. Design: We performed a case-control prospective study from March 2012 to May 2014. Setting: Inpatients at the Division of Neurology, Department of Clinical and Experimental Sciences, Brescia. Population: We enrolled 79 patients with clinical and radiological findings of iNPH and 300 healthy adults over 70 years old without GD as a control group. Methods: We performed gait analysis, CSF Tap Test (TT), and shunt surgery in all patients with a diagnosis of iNPH according to the International Guidelines. According to clinical outcomes, we divided patients in responsive (group A) and non-responsive (group B). We then compared pre-operative gait analysis of group A with the control group, and calculated the percentage of improvement after TT between group A and group B. Results: Shunt surgery was performed in 52 patients. After 3 months, 35 patients (group A: 67.3%) showed a positive response to shunt. We quantified the impaired gait parameters in iNPH and assessed the differences with controls. Improvement of speed, stride length and double support time after TT was predictive of positive shunt response. Conclusions: The proposed inertial sensor system is a reliable and easy-to-use system for early detection of iNPH and may be used in any clinical setting. Clinical Rehabilitation Impact: Identification of a GD pattern for iNPH, especially in rehabilitation, may be useful for recognizing patients who are candidates for surgery, thus avoiding permanent disability
5-aminolevulinic acid and neuronavigation in high-grade glioma surgery: results of a combined approach.
No full textAcute functional reactivation of the language network during awake intraoperative brain mapping
No full textAcute brain plasticity during resection of central lesions has been recently described. In the cases reported, perilesional latent networks, useful to preserve the neurological functions, were detected in asymptomatic patients. In this paper, we presented a case of acute functional reactivation (AFR) of the language network in a symptomatic patient. Tumor resection allowed to acutely restore the neurological deficit. Intraoperative direct cortical stimulation (DCS) and functional neuroimaging showed new epicentres of activation of the language network after tumor excision. DCS in awake surgery is mandatory to reveal AFR needful to improve the extent of resection preserving the quality of life
- …
