Clinical Neuroscience

[Biportal neuroendoscopy of the prepontine cisterns]

REISCH Róbert, FRIES Georg, PATONAY Lajos, PERNECZKY Axel

APRIL 20, 2003

Clinical Neuroscience - 2003;56(03-04)

[Introduction - While bi- or multiportal approaches have been adopted in different fields of surgery including abdominal and spine surgery, the uniportal access into the skull is a traditional principle in neurosurgery. In this preclinical cadaver study the authors developed combinations of biportal endoneurosurgical dissections in the prepontine subarachnoid space to test the safety of this technique. Methods - In 34 fresh post-mortem adult human cadavers and 14 formaldehyde-fixed adult human head specimen a total of 48 biportal endoscopical dissections were carried out. 0°, 30°, and 70° lens scopes with a diameter of 1.7 and 4.2 mm and trochars with a diameter of 5.0 to 6.5 mm were used. Results - Six different endoscopic routes to the prepontine region and a total of 10 different combinations of this approaches could be described. Useful and safe biportal combinations were: 1. supraorbital on both sides, 2. supraorbital combined with ipsilateral anterior subtemporal, 3. supraorbital combined with contralateral anterior subtemporal, 4. supraorbital combined with ipsilateral posterior subtemporal, 5. supraorbital combined with ipsilateral frontal interhemispheric, 6. supraorbital combined with contralateral frontal interhemispheric, 7. anterior subtemporal combined with ipsilateral frontal interhemispheric, 8. anterior subtemporal combined with contralateral frontal interhemispheric. Conclusion - The biportal endomicrosurgical strategy offered effective and safe dissections within the prepontine subarachnoid space.]

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[Farewell to dr. Edit Martini]

NAGY Zoltán

[Farewell to dr. Edit Martini memorial 2003;56(03-04)]

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[Facts and memories of Kálmán Sántha 2003;56(03-04)]

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[Occipital spectral EEG-parameters in newly diagnosed, untreated epilepsy patients]

CLEMENS Béla, BESSENYEI Mónika

[Introduction - Minor spectral EEG alterations hidden to the naked eye may be of interest in the field of epileptology, cognitive performances, and drug effects. In order to introduce new scientific results of brain wave research into the clinical field of epilepsy- and drug-related cognitive problems, a normative quantitative EEG database for epilepsy was constructed. Patients and methods - 171 newly referred, five to 50 years old patients with untreated ”new” epilepsy (that is, clinical, EEG, MRI investigations had been done in 24 months after the first unprovoked seizure) were collected. EEG was recorded with closed eyes, in the waking-relaxed state. Effects that are known to influence EEG spectra (nearby seizures, drugs, etc.) were excluded as far as possible. A total of two minutes of waking-resting EEG activity was chosen for spectral analysis. Fast Fourier transformation of the selected samples were calculated resulting in absolute power, percent power and mean alpha frequency (AA, RA, and AMF respectively) for the right and left occipital derivations. For each patient (and also for 37 healthy controls), the deviation of the individual values from the age-adjusted normative mean was expressed in Z-score. Main diagnostic epilepsy categories were compared to the control group as well as to each other. In addition, effects of MRI-defined cerebral lesions and interictal spiking on spectral EEG parameters were investigated. Results - All group averages were within the 95 per cent confidence interval. Overwhelming majority of the individual data fell within a 3Z range. Statistically significant differences were found for AA and RA, but seldom for AMF. Right and left alpha-parameters were surprisingly symmetrical in all groups. The main difference between epilepsy groups and controls was less AA and RA power in the epilepsy groups. MRI-defined lesions and interictal epileptiform activity did not significantly influence EEG spectral variables. Conclusion - These results might serve as reference data and might help planning of further quantitative EEG studies in the triangle of epilepsy, cognitive problems, and drug effects.]

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