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  • Cerebellopontine angle arachnoid cyst containing ectopic choroid plexus--case report.

    26 April 2018

    We present a rare and interesting case of a cerebellopontine angle cyst containing ectopic choroid plexus tissue in a 26 year-old female. Surgical resection was performed, and histological examination confirmed the presence of choroid plexus in the cyst wall. This is the first reported case of ectopic choroid plexus at the cerebellopontine angle in an adult. We present the case and review the literature.

  • Acute Traumatic Brain Injury: A Review of Recent Advances in Imaging and Management.

    27 April 2018

    Acute traumatic brain injury (TBI) is a major cause of death and disability in young persons worldwide, producing a substantial economic burden on health services. New technology in computed tomography and magnetic resonance imaging is allowing the acquisition of more accurate and detailed information on cerebral pathology post-TBI. This has greatly improved prognostic ability in TBI and enables earlier identification of pathology, making it potentially amenable to therapeutic intervention. Recent advances in the management of TBI have been hampered by a lack of class I evidence arising from difficulties in applying strict study protocols to a patient subset as heterogeneous as post-TBI patients. The most definite benefits in terms of survival after TBI come from admission to a specialist neurosurgical centre, with goal-targeted therapy and intensive care services. Some traditional therapies for the treatment of acute TBI have been proven to be harmful and should be avoided. A number of management strategies have proved potentially beneficial post-TBI, but there is insufficient evidence to make definitive recommendations at present. Future therapies that are currently under investigation include decompressive craniectomy, progesterone therapy, and possibly therapeutic hypothermia.

  • Persistent suppression of subthalamic beta-band activity during rhythmic finger tapping in Parkinson's disease

    26 April 2018

    Objective: The function of synchronous oscillatory activity at beta band (15-30. Hz) frequencies within the basal ganglia is unclear. Here we sought support for the hypothesis that beta activity has a global function within the basal ganglia and is not directly involved in the coding of specific biomechanical parameters of movement. Methods: We recorded local field potential activity from the subthalamic nuclei of 11 patients with Parkinson's disease during a synchronized tapping task at three different externally cued rates. Results: Beta activity was suppressed during tapping, reaching a minimum that differed little across the different tapping rates despite an increase in velocity of finger movements. Thus beta power suppression was independent of specific motor parameters. Moreover, although beta oscillations remained suppressed during all tapping rates, periods of resynchronization between taps were markedly attenuated during high rate tapping. As such, a beta rebound above baseline between taps at the lower rates was absent at the high rate. Conclusion: Our results demonstrate that beta desynchronization in the region of the subthalamic nucleus is independent of motor parameters and that the beta resynchronization is differentially modulated by rate of finger tapping,. Significance: These findings implicate consistent beta suppression in the facilitation of continuous movement sequences. © 2012 International Federation of Clinical Neurophysiology.

  • Cord compression secondary to intradural ossification.

    26 April 2018

    The authors describe two patients presenting with a previous history of spinal trauma and a several-year history of sensory changes secondary to spinal cord compression. Both patients underwent laminectomy and spinal decompression operations. In both cases intradural bone causing neural compression was removed at operation. Potential mechanisms to explain intradural ossification and the relevant literature are reviewed.

  • Mapping the central neurocircuitry that integrates the cardiovascular response to exercise in humans

    28 November 2017

    There are abundant animal data attempting to identify the neural circuitry involved in cardiovascular control. Translating this research into humans has been made possible using functional neurosurgery during which deep brain stimulating electrodes are implanted into various brain nuclei for the treatment of chronic pain and movement disorders. This not only allows stimulation of the human brain, but also presents the opportunity to record neural activity from various brain regions. This symposium review highlights key experiments from the past decade that have endeavoured to identify the neurocircuitry responsible for integrating the cardiovascular response to exercise in humans. Two areas of particular interest are highlighted: the periaqueductal grey and the subthalamic nucleus. Our studies have shown that the periaqueductal grey (particularly the dorsal column) is a key part of the neurocircuitry involved in mediating autonomic changes adapted to ongoing behaviours. Emerging evidence also suggests that the subthalamic nucleus is not only involved in the control of movement, but also in the mediation of cardiovascular responses. Although these sites are unlikely to be the 'command' areas themselves, we have demonstrated that the two nuclei have the properties of being key integrating sites between the feedback signals from exercising muscle and the feedforward signals from higher cortical centres. © 2011 The Authors. Experimental Physiology © 2012 The Physiological Society.

  • Mapping the central neurocircuitry that integrates the cardiovascular response to exercise in humans.

    30 April 2018

    There are abundant animal data attempting to identify the neural circuitry involved in cardiovascular control. Translating this research into humans has been made possible using functional neurosurgery during which deep brain stimulating electrodes are implanted into various brain nuclei for the treatment of chronic pain and movement disorders. This not only allows stimulation of the human brain, but also presents the opportunity to record neural activity from various brain regions. This symposium review highlights key experiments from the past decade that have endeavoured to identify the neurocircuitry responsible for integrating the cardiovascular response to exercise in humans. Two areas of particular interest are highlighted: the periaqueductal grey and the subthalamic nucleus. Our studies have shown that the periaqueductal grey (particularly the dorsal column) is a key part of the neurocircuitry involved in mediating autonomic changes adapted to ongoing behaviours. Emerging evidence also suggests that the subthalamic nucleus is not only involved in the control of movement, but also in the mediation of cardiovascular responses. Although these sites are unlikely to be the 'command' areas themselves, we have demonstrated that the two nuclei have the properties of being key integrating sites between the feedback signals from exercising muscle and the feedforward signals from higher cortical centres.

  • Autonomic neurosurgery: from microvascular decompression to image guided stimulation.

    16 March 2018

    The paper reviews mechanisms underlying autonomic disorders, with a focus on cardiovascular dysfunction. Neurosurgical approaches are described for medically refractory hypertension and orthostatic hypotension. After review of microvascular decompression of the rostral ventrolateral medulla, stereotactic CT and MRI guided deep brain stimulation of the periaqueductal grey matter (PAG) is evaluated. Results are presented from patient studies showing reductions in blood pressure with ventral PAG stimulation and increases in blood pressure with dorsal PAG stimulation. A rationale for the treatment of autonomic disorders by neurosurgical intervention is discussed.