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Alfonso Schettini, Lachlan McKay, Raymond Majors, Joseph Mahig, and Arnold H. Nevis

the intact abdominal wall. 26 This same principle was used in the MacKay-Marg method of tonometry, which enabled intraocular pressure to be determined simply and accurately. 11, 15, 21 We have applied this well-established principle to monitoring brain surface pressure through the intact dura. Principles of Epidural Monitoring The intracranial contents are enveloped by membranes. One of these, the dura, is a tough, elastic membrane which covers the brain. If a transducer is pressed against the dural membrane when it is slack, it can measure the forces

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Monitoring retraction pressure on the brain

An experimental and clinical study

Kazuhiro Hongo, Shigeaki Kobayashi, Akira Yokoh, and Kenichiro Sugita

I N the majority of neurosurgical operations, brain retraction is an essential technique that often influences operative results. Every neurosurgeon knows from his own experience the safe limits of retraction pressure. Despite the importance of this aspect of brain surgery, however, there have been few clinical studies of brain retraction. 2 Since our previous report, 19 we have developed a new monitoring system that enables quantitative measurement of retraction pressure and is applicable clinically. This report discusses the basic principles of brain

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Haydn Hoffman, Karl Abi-Aad, Katherine M. Bunch, Timothy Beutler, Fadar O. Otite, and Lawrence S. Chin

T raumatic brain injury (TBI) is a leading cause of morbidity and mortality, which accounted for 2.8 million emergency department visits, hospitalizations, and deaths in 2013. 1 Severe TBI (sTBI), defined as having a Glasgow Coma Scale (GCS) score ≤ 8, is associated with high rates of mortality and poor functional outcome. Management is aimed at avoiding secondary injury by reducing brain swelling and optimizing cerebral perfusion and oxygenation. Current guidelines by the Brain Trauma Foundation recommend intracranial pressure (ICP) monitoring in

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Gerald A. Grant, Donald Farrell, and Daniel L. Silbergeld

SSEP mapping can be corroborated by cortical stimulation mapping of motor cortex. The use of intraoperative monitoring of SSEPs prior to resection is a well-established technique to localize functional primary somatosensory cortex. 1, 4 We evaluated the novel technique of continuous SSEP monitoring during resection of parietal neoplasms adjacent to primary somatosensory cortex (S1) and ascending somatosensory white matter tracts. Four case examples are presented. Surgical Technique Techniques for intraoperative SSEP mapping are similar to those used for

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Aziz S. Alali, David Gomez, Chethan Sathya, Randall S. Burd, Todd G. Mainprize, Richard Moulton, Richard A. Falcone Jr., Charles de Mestral, and Avery Nathens

ICP monitoring via an invasive tool might facilitate the early detection of elevated ICP, which can enable prompter treatment to control the rising ICP. Invasive ICP monitoring in pediatric patients first became part of the Brain Trauma Foundation guidelines for the management of severe TBI in children in 2003. 1 , 22 The Level III recommendation of ICP monitoring use was based on the high incidence of intracranial hypertension among children with severe TBI and the strong association between high ICP and poor neurological outcome. 2 , 8 , 18 , 22 Well

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Betty L. Grundy, Peter J. Jannetta, Phyllis T. Procopio, Agnes Lina, J. Robert Boston, and Earl Doyle

neurologically and audiometrically normal adults (rarefaction clicks at 10 Hz and 70 dB greater than the patient's sensation level (hearing threshold), 2000 to 6000 repetitions, filters 100 to 3000 Hz). Because BAEP provide information about the functional integrity of neural structures that can otherwise be obtained only by clinical assessment of unanesthetized patients, 5, 26 these potentials offer promise as a means of monitoring the auditory nerve and brain stem during neurosurgical operations that place these structures at risk. 3, 8–11, 25 We examined the

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Peter A. Raudzens and Andrew G. Shetter

A n objective means of continuously monitoring neurophysiological function in the brain stem and cochlear nerve may be of considerable assistance to surgeons operating within the posterior and middle fossa. Some postoperative neurological deficits may be secondary to excess mechanical traction or vascular insufficiency rather than physical transection of neural structures. These might be avoidable if deterioration could be recognized and corrected promptly before irreversible changes occurred. Since their initial description by Jewett and Williston 4 in 1971

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Michael F. Stiefel, Alejandro Spiotta, Vincent H. Gracias, Alicia M. Garuffe, Oscar Guillamondegui, Eileen Maloney-Wilensky, Stephanie Bloom, M. Sean Grady, and Peter D. LeRoux

brain tissue PO 2 is a useful complement to ICP monitoring in severe TBI therapy. 4, 10, 11, 15, 17, 19, 23, 43, 45–47 This theory makes intuitive sense given that the brain is highly dependent on a continuous supply of O 2 to maintain cellular integrity. 50 In particular, several investigators have described a significant relationship between poor patient outcome and the number, duration, and intensity of cerebral hypoxia episodes (brain tissue PO 2 < 15 mm Hg). 1, 11, 23, 47, 48 Authors of these studies did not definitively determine whether treatment of

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Eveline M. Gutzwiller, Ivan Cabrilo, Ivan Radovanovic, Karl Schaller, and Colette Boëx

R esection of intrinsic brain tumors that are close to either the optic nerves, visual tracts, or occipital cortices can cause deterioration of visual function. Typically, these complications occur in procedures for tumors of or around optic nerves 4 and in temporal lobectomies either for epilepsy surgery 1 , 7 , 17 , 18 or for temporal neoplasms. 2 Brain surgeries for parietal and occipital lesions associated with the optic radiations or the visual cortex also carry an intrinsic risk of visual impairment. 19 Whereas intraoperative motor monitoring has been

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Eveline M. Gutzwiller, Ivan Cabrilo, Ivan Radovanovic, Karl Schaller, and Colette Boëx

R esection of intrinsic brain tumors that are close to either the optic nerves, visual tracts, or occipital cortices can cause deterioration of visual function. Typically, these complications occur in procedures for tumors of or around optic nerves 4 and in temporal lobectomies either for epilepsy surgery 1 , 7 , 17 , 18 or for temporal neoplasms. 2 Brain surgeries for parietal and occipital lesions associated with the optic radiations or the visual cortex also carry an intrinsic risk of visual impairment. 19 Whereas intraoperative motor monitoring has been