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Wise Young, Vincent DeCrescito and John J. Tomasula

r < 0.9900 were discarded. The slopes were multiplied by 100 to express the flow rates in units of ml/100 gm/min. A two-tailed t-test was used to assess statistical significance of blood flow changes. Lateral column recording sites were confirmed histologically at the end of the experiment. Neurophysiological Monitoring The SEP's were elicited by stimulation of the sciatic nerve (2.3/sec, 2 × twitch threshold) and recorded epidurally from the contralateral somatosensory cortex. After × 10,000 amplification and filtering (bandpass 150 to 3000 Hz), 256

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H. Hunt Batjer, Alan I. Frankfurt, Phillip D. Purdy, Shirley S. Smith and Duke S. Samson

demonstrate that the CMRO 2 is significantly affected by doses of this magnitude, and animal studies as well as this clinical experience support the safety of this regimen. It is our impression that the cardiovascular depression associated with etomidate is substantially less severe than that observed with high doses of barbiturates and that postoperative recovery of consciousness is much quicker, allowing earlier neurological assessment. The development of this therapeutic protocol involving cerebral metabolic depression, neurophysiological monitoring, temporary local

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Arnold H. Menezes and John C. VanGilder

external oblique aponeurosis adjacent to the dural closure. A fat pad was then used to reinforce the fascia. The longus colli muscles, the pharyngeal musculature, and the mucosa were approximated in individual layers using dyed 3-0 Vicryl sutures. The soft palate was closed in two layers and the pharyngeal pack was removed. Intraoperative somatosensory evoked potentials and brain-stem auditory evoked responses were recorded preoperatively and intraoperatively as neurophysiological monitors. 7, 35, 42, 43 Subsequent to surgery the patient was maintained with 5 lbs of

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The transoral approach to the superior cervical spine

A review of 53 cases of extradural cervicomedullary compression

Mark N. Hadley, Robert F. Spetzler and Volker K. H. Sonntag

reassessment. The depth, width, and rostral and caudal extents of the decompression can be documented at the time of surgery. The use of positive-contrast dye in the resection cavity can identify persistent compressive pathology and facilitates a more complete and thorough decompression of the brain stem or rostral spinal cord structures ( Fig. 3 ). Neurophysiological Monitoring The transoral operation is a high-risk surgical procedure when treating patients with significant brain-stem or spinal cord compression. Any further compromise, even if transient, has the

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Robert C. Rostomily, Mitchel S. Berger, George A. Ojemann and Ettore Lettich

data with magnetic resonance imaging. J Neurosurg 72 : 383 – 387 , 1990 Berger MS, Cohen WA, Ojemann GA: Correlation of motor cortex brain mapping data with magnetic resonance imaging. J Neurosurg 72: 383–387, 1990 4. Berger MS , Ojemann GA , Lettich E : Neurophysiological monitoring during astrocytoma surgery. Neurosurg Clin North Am 1 : 65 – 80 , 1990 Berger MS, Ojemann GA, Lettich E: Neurophysiological monitoring during astrocytoma surgery. Neurosurg Clin North Am 1: 65–80, 1990 5

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Robert G. Ojemann

microsurgical techniques to skull-base lesions previously thought to be inoperable. Al-Mefty 1 has also reported on the technique of extensive resection of these tumors. While technical achievements are well documented, the use of intraoperative neurophysiological monitoring, including electroencephalography, somatosensory evoked potentials, brain-stem evoked responses, and at times cranial nerve testing, is only briefly mentioned. Monitoring can be helpful but it is expensive. Møller, 5 who is from the same institution as the authors, has published extensively on

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Laligam N. Sekhar, Shlomo Pomeranz, Ivo P. Janecka, Barry Hirsch and Sai Ramasastry

with replacement red cells and coagulation factors. Neurophysiological monitoring includes an electroencephalogram, somatosensory evoked responses, and brain-stem evoked responses from the contralateral ear. Cranial nerve monitoring is used when preservation of cranial nerves is a goal. The patient is placed supine with the head rotated 60° contralaterally or in a lateral decubitus position, depending upon the need for extraction of the saphenous vein, sural nerve graft, or myocutaneous flaps. Initial Approach The initial steps are similar both for fast

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Georges Fischer, Catherine Fischer and Joël Rémond

. Fischer C , Fischer G : Intraoperative brainstem auditory evoked potential (BAEP) monitoring in acoustic neuroma surgery , in Schramm J , Møller AR (eds): Intraoperative Neurophysiologic Monitoring in Neurosurgery. Heidelberg : Springer-Verlag , 1991 , pp 187 – 192 Fischer C, Fischer G: Intraoperative brainstem auditory evoked potential (BAEP) monitoring in acoustic neuroma surgery, in Schramm J, Møller AR (eds): Intraoperative Neurophysiologic Monitoring in Neurosurgery. Heidelberg: Springer-Verlag, 1991, pp 187

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Michael M. Haglund, Mitchel S. Berger, Dennis D. Kunkel, JoAnn E. Franck, Saadi Ghatan and George A. Ojemann

, Kupfer WR, et al: Glutamate decarboxyiase-immunoreactive neurons are preserved in human epileptic hippocampus. J Neurosci 9: 2562–2574, 1989 5. Bakay RAE , Harris AB : Neurotransmitter, receptor, and biochemical changes in monkey cortical epileptic foci. Brain Res 206 : 387 – 404 , 1981 Bakay RAE, Harris AB: Neurotransmitter, receptor, and biochemical changes in monkey cortical epileptic foci. Brain Res 206: 387–404, 1981 6. Berger MS , Ojemann GA , Lettich E : Neurophysiological monitoring

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Atul Goel, Laligam N. Sekhar, Walter Langheinrich, Donald Kamerer and Barry Hirsch

W ith the wide availability of computerized tomography (CT) scanning and magnetic resonance (MR) imaging with gadolinium enhancement, acoustic neurilemomas are increasingly being diagnosed while still small or medium-sized. The wide application of microsurgical technique and neurophysiological monitoring of cranial nerves and the brain stem has greatly reduced the incidence of death and brain-stem injury after acoustic tumor resection. Excellent facial nerve function is commonly preserved after such operations. The present challenge of acoustic neurilemoma