652 research outputs found
Temporobasal, Transsphenoidal Meningoencephalocele Becoming Symptomatic with Spontaneous Cerebrospinal Fluid Rhinorrhea: Diagnostic Work-up and Microsurgical Strategy
No full textBackgroundWe report the rare case of an adult transsphenoidal meningoencephalocele and outline the microneurosurgical strategy. Clinical history, the findings of computerized tomography (CT) scans and magnetic resonance imaging (MRI), the microsurgical procedure, and histopathology are reported. Case ReportA 54-year-old female patient complained about cerebrospinal fluid (CSF) rhinorrhea; a transnasal biopsy of a mass in the maxillar sinus prior to diagnostic work-up was performed elsewhere. Persisting CSF leakage prompted CT and MRI, which showed brain tissue extending from the left middle cranial fossa into the left sphenoid sinus through several bony defects. The diagnosis of a transsphenoidal meningoencephalocele was made, and the lesion was targeted via a subtemporal intradural approach with resection of the herniated brain tissue and closure of the bony as well as of dural defects. The postoperative course was uneventful without recurrence of the CSF fistula. ConclusionThe transsphenoidal subtype of basal meningoencephaloceles is exceedingly rare. Nonetheless, it has to be considered as a differential diagnosis if a nasal or intrasphenoidal mass is diagnosed. Otherwise, unjustified biopsy or unsuccessful management of CSF leakage could not be avoided. The intradural subtemporal approach is effective to treat the transsphenoidal type of basal meningoencephaloceles
Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement
No full textRobotic-guided and percutaneous pedicle screw placement are emerging technologies. We here report a retrospective cohort analysis comparing conventional open to open robotic-guided and percutaneous robotic-guided pedicle screw placement. 112 patient records and CT scans were analyzed concerning the intraoperative and perioperative course. 35 patients underwent percutaneous, 20 open robotic-guided and 57 open conventional pedicle screw placement. 94.5% of robot-assisted and 91.4% of conventionally placed screws were found to be accurate. Percutaneous robotic and open robotic-guided subgroups did not differ obviously. Average X-ray exposure per screw was 34 s in robotic-guided compared to 77 s in conventional cases. Subgroup analysis indicates that percutaneously operated patients required less opioids, had a shorter hospitalization and lower rate of adverse events in the perioperative period. The use of robotic guidance significantly increased accuracy of screw positioning while reducing the X-ray exposure. Patients seem to have a better perioperative course following percutaneous procedures
Processing of inconsistent emotional information: an fMRI study
No full textPrevious studies investigating the anterior cingulate cortex (ACC) have relied on a number of tasks which involved cognitive control and attentional demands. In this fMRI study, we tested the model that ACC functions as an attentional network in the processing of language. We employed a paradigm that requires the processing of concurrent linguistic information predicting that the cognitive costs imposed by competing trials would engender the activation of ACC. Subjects were confronted with sentences where the semantic content conflicted with the prosodic intonation (CONF condition) randomly interspaced with sentences which conveyed coherent discourse components (NOCONF condition). We observed the activation of the rostral ACC and the middle frontal gyrus when the NOCONF condition was subtracted from the CONF condition. Our findings provide evidence for the involvement of the rostral ACC in the processing of complex competing linguistic stimuli, supporting theories that claim its relevance as a part of the cortical attentional circuit. The processing of emotional prosody involved a bilateral network encompassing the superior and medial temporal cortices. This evidence confirms previous research investigating the neuronal network that supports the processing of emotional information
Non-stimulant medications in the treatment of ADHD
No full textBackground. Stimulants are the first-line medication in the psychopharmacological treatment of attention-deficit hyperactivity disorder (ADHD). However, 10 to 30% of all children and adults with ADHD either do not respond to or do not tolerate treatment with stimulants. Objective. To describe alternative treatment approaches with various non-stimulant agents, especially atomoxetine. Method. General review of empirically based literature concerning efficacy and safety of the substances. Results. A large and still increasing body of data supports the usefulness of atomoxetine, a once daily dosing, and new selective noradrenalin reuptake inhibitor, with few side effects. Atomoxetine has been licensed in the US for use in ADHD across the lifespan, and is currently under consideration in Europe. Other non-stimulant substances, such as tricyclic antidepressants (TCAs) and alpha-2-adrenergic agonists, which are used to treat ADHD, are also reviewed. TCAs have been well studied and shown to be efficacious in the treatment of ADHD, but are limited by side effects. The number of studies documenting the efficacy of alpha-2-adrenergic agonists is still limited. Some experimental studies support a potential role of cholinergic drugs such as acetylcholinesterase inhibitors (tacrine, donepezil) as well as novel nicotinic analogues (ABT-418). Conclusion. Non-stimulant agents have been shown to be effective in treatment of ADHD. Especially, atomoxetine seems promising and newline drugs are in development
Brain self-regulation in criminal psychopaths
No full textPsychopathic individuals are characterized by impaired affective processing, impulsivity, sensation-seeking, poor planning skills and heightened aggressiveness with poor self-regulation. Based on brain self-regulation studies using neurofeedback of Slow Cortical Potentials (SCPs) in disorders associated with a dysregulation of cortical activity thresholds and evidence of deficient cortical functioning in psychopathy, a neurobiological approach seems to be promising in the treatment of psychopathy. The results of our intensive brain regulation intervention demonstrate, that psychopathic offenders are able to gain control of their brain excitability over fronto-central brain areas. After SCP self-regulation training, we observed reduced aggression, impulsivity and behavioral approach tendencies, as well as improvements in behavioral-inhibition and increased cortical sensitivity for error-processing. This study demonstrates improvements on the neurophysiological, behavioral and subjective level in severe psychopathic offenders after SCP-neurofeedback training and could constitute a novel neurobiologically-based treatment for a seemingly change-resistant group of criminal psychopaths
Decompressive craniotomy: durotomy instead of duroplasty to reduce prolonged ICP elevation
No full textThe image of illness in Veit Stoss’s works of art
No full textThe article takes up the issue of ideological connections between the philosophy of man developed in the 15th century by the Cracovian masters from the Universitatis Cracoviensis and Cracovian Gothic art, above all the sculptures created by Veit Stoss in his Cracovian period. The German master-carver showed in his Cracovian Altarpiece a vast range of individual portrait-studies, realistic and naturalistic in character. During the Cracovian period some essential transformations took place in Veit Stoss’s oeuvre. He created naturalistic portrait-studies unknown in the European art of the time, depicting even pathological changes, such as cancerous skin lesions,which Stoss perceived on the human body. We have known – on the basis of archival sources – that Veit Stoss maintained friendly contacts with Jan of Głogów, author of the treatise Physionomia hincinde ex illustribus scriptoribus per venerabilem virum magistrum Joannem Glogoviensem diligentissime recol lecta, printed in Kraków in 1518. I wish to prove that the content of this treatise – includingtheissueofskindiseases – found its reflection in the art of one of the leading sculptors of the late medieval Europe
Towards the cost-benefit function of peripheral vision in sports
No full textPeripheral vision seems especially valuable in dual-task situations that require the pro-cessing of motion-related information, such as sports tasks of monitoring players and ini-tiating a motor response (Williams, Janelle, & Davids, 2004). With a multiple-object track-ing/change-detection dual-task that mimics exactly these demands in a lab setting, we could show that peripheral vision is used for object monitoring and change detection, with particular sensitivity to motion changes in the latter (Vater, Kredel & Hossner, 2016, 2017). In the present follow-up study, we determine how high vs. low visual and attentional de-mands affect performance and gaze behaviour in these dual-task situations.
Fourteen participants were tested in a MOT task that required the monitoring of 4 targets among 10 moving squares for 6 s. As a secondary task, a button had to be pressed if a target stopped moving. Gaze was measured with a mobile eye-tracker (EyeSeeCam, 220 Hz), integrated in a motion-capture system (Optitrack, 200 Hz). In a 2 x 2 experimental de-sign, visual demands (temporary crowding of three “group targets” by three distractors) and attentional demands (collisions between the “group targets” and the frame) were ma-nipulated. Gaze-anchoring distance to the group targets, the percentage of trials with sac-cades to the group targets, as well as tracking and detection accuracy were calculated.
As expected, in the crowd compared to the no-crowd condition, tracking performance was lower, F(1,13) = 103.80, p < .01, ηp2 = .89, and gaze was anchored closer to the group tar-gets, F(1,13) = 13.78, p < .01, ηp2 = .52, highlighting configuration-dependent eccentricity costs. In the collision conditions, a main effect for collision, F(1,13) = 239.94, p < .01, ηp2 = .95, presented the largest ANOVA effect size, indicating that more saccades are initiated before than after the collision. A comparison of change detection rates with and without anticipatory saccades showed that detection accuracy is reduced if the saccades occur during the period of the target change, F(1,13) = 5.81, p = .03, ηp2 = .31. This finding em-phasizes that saccade costs must be considered in the optimisation of gaze behaviour.
For sports, our findings suggest that – rather than fixating sequentially on relevant cues – athletes should anchor their gaze between objects in a cost-optimised manner and espe-cially, refrain from saccades if a crucial event is anticipated in the following moments. We are currently testing this conceptualized cost-dependent optimisation of gaze behaviour in sport-specific dual-task situations (e.g., with action responses in martial arts, basketball and soccer).
References
Vater, C., Kredel, R., & Hossner, E.-J. (2016). Detecting single-target changes in multiple object tracking: The case of peripheral vision. Attention, Perception, & Psychophysics, 78, 1004–1019.
Vater, C., Kredel, R., & Hossner, E.-J. (2017). Detecting target changes in multiple object tracking with pe-ripheral vision: More pronounced eccentricity effects for changes in form than in motion. Journal of Experimental Psychology: Human Perception & Performance, 43, 903–913.
Williams, A. M., Janelle, C. M., & Davids, K. (2004). Constraints on the search for visual information in sport. International Journal of Sport and Exercise Psychology, 2, 301–318
Literatur-Rundschau
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Intra-osseous ultrasound for pedicle screw positioning in the subaxial cervical spine: an experimental study
No full textIn contrast to other regions of the human spine, dorsal fixation with rods and pedicle screws is comparatively rarely performed in the cervical spine. Although this technique provides a higher mechanical strength than the more frequently used lateral mass screws, many surgeons fear the relatively high rate of misplacements. This higher incidence is mainly due to the complex vertebral anatomy in this spinal segment. For correct screw placement, the availability of an immediate and efficient intra-operative imaging tool to ascertain the accuracy of the pedicle screw hole position would be beneficial. We have previously investigated the usefulness of an intraspinal, specifically, intra-osseous ultrasound technique in the lumbar spine. In this study its accuracy as a means of controlling intrapedicular screw hole positioning has been evaluated in the cervical spine. An endovascular ultrasound transducer was used for the intra-luminal scanning of 54 pedicle screw holes in cadaveric human spine specimens. Twenty-three of these had been intentionally misplaced (cortex breached). The resulting image files were assessed by three investigators blinded to both the procedure and the corresponding CT findings. The investigators differentiated correctly between adequately and poorly placed pedicle screw holes in 96% of cases. False negatives and false positives both occurred in no more than 1.8% of cases. Intrapedicular ultrasonography of pedicle screw holes in the cervical spine is a promising technique for the intra-operative assessment of bore hole placement and may increase operative safety and postoperative outcome in posterior cervical fusion surgery
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