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1.
Oper Neurosurg (Hagerstown) ; 17(2): 208-226, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30753637

RESUMO

BACKGROUND: Endoscopic and microneurosurgical approaches to third ventricular lesions are commonly performed under general anesthesia. OBJECTIVE: To report our initial experience with awake transsulcal parafascicular corridor surgery (TPCS) of the third ventricle and its safety, feasibility, and limitations. METHODS: A total of 12 cases are reviewed: 6 colloid cysts, 2 central neurocytomas, 1 papillary craniopharyngioma, 1 basal ganglia glioblastoma, 1 thalamic glioblastoma, and 1 ependymal cyst. Lesions were approached using TPCS through the superior frontal sulcus. Pre-, intra-, and postoperative neurocognitive (NC) testing were performed on all patients. RESULTS: No cases required conversion to general anesthesia. Awake anesthesia changed intraoperative management in 4/12 cases with intraoperative cognitive changes that required port re-positioning; 3/4 recovered. Average length of stay (LOS) was 6.1 d ± 6.6. Excluding 3 outliers who had preoperative NC impairment, the average LOS was 2.5 d ± 1.2. Average operative time was 3.00 h ± 0.44. Average awake anesthesia time was 5.05 h ± 0.54. There were no mortalities. CONCLUSION: This report demonstrated the feasibility and safety of awake third ventricular surgery, and was not limited by pathology, size, or vascularity. The most significant factor impacting LOS was preoperative NC deficit. The most significant risk factor predicting a permanent NC deficit was preoperative 2/3 domain impairment combined with radiologic evidence of invasion of limbic structures - defined as a "NC resilience/reserve" in our surgical algorithm. Larger efficacy studies will be required to demonstrate the validity of the algorithm and impact on long-term cognitive outcomes, as well as generalizability of awake TPCS for third ventricular surgery.


Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Sedação Consciente/métodos , Procedimentos Neurocirúrgicos/métodos , Terceiro Ventrículo/cirurgia , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
2.
Appl Neuropsychol Adult ; 23(5): 384-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27218477

RESUMO

Despite being one of the most widely used measures in clinical neuropsychology, the Trail Making Test is highly reliant on intact vision and motor functioning. Given that these capacities are often compromised in patients requiring neuropsychological evaluation, various authors have proposed methods for adapting the Trail Making Test for oral administration. To date, a number of administration and score transformation methods have been proposed. We reviewed the existing literature on oral adaptation of the Trail Making Test in order to provide recommendations for practicing clinicians wishing to use the measure, and to highlight directions for future research.


Assuntos
Estimulação Acústica , Neuropsicologia/métodos , Neuropsicologia/tendências , Teste de Sequência Alfanumérica , Humanos
3.
Am J Alzheimers Dis Other Demen ; 30(2): 145-52, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24990889

RESUMO

Memory decline is often among the first signs heralding the emergence of mild cognitive impairment or dementia regardless of etiology. Despite its limited inclusion of memory screening, the Mini-Mental State Exam (MMSE) continues to be the most ubiquitous, first-line screening tool for dementia and cognitive decline. In response to well documented problems with the sensitivity of this instrument and the growing importance of cognitive screening, we assessed the utility of the MMSE as a screening tool among older adults presenting for evaluation at a memory clinic. The Standardized MMSE and a standardized verbal memory test - the Hopkins Verbal Learning Test-Revised (HVLT-R) - were administered to 304 consecutive referrals at a university-based outpatient memory clinic. Among patients scoring above 25 on the MMSE (n = 169), over half exhibited at least moderate memory impairment (HVLT-R delayed recall z ≤ -2.0) and more than 25% showed severe impairment (delayed recall z ≤ -3.0). Perhaps even more striking was that among those who achieved perfect (30/30) or near perfect (29/30) scores on the MMSE (n = 70), 43% displayed moderate to severe memory impairment. Although newer screening measures have shown improved sensitivity, more in-depth memory testing appears to be a vital component of successful screening and early detection.


Assuntos
Transtornos da Memória/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Psicometria/instrumentação , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Rememoração Mental/fisiologia , Testes Neuropsicológicos/normas , Padrões de Referência , Sensibilidade e Especificidade
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