Acta neurochirurgica
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Acta neurochirurgica · Jul 2009
Comparative StudyDecompressive laminoplasty in multisegmental cervical spondylotic myelopathy: bilateral cutting versus open-door technique.
The aim of the study was to evaluate patients with multisegmental cervical spondylotic myelopathy (MCM) surgically treated via a dorsal approach. Two different laminoplasty techniques were compared by assessment of enlargement of the spinal canal and the neurological outcome. ⋯ Decompressive laminoplasty is comparable with anterior surgery in neurological outcome. The OD technique seems to be superior to our BL technique regarding both the enlargement of SD and complication rate.
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Acta neurochirurgica · Jul 2009
Deep brain stimulation of the internal globus pallidus in dystonia: target localisation under general anaesthesia.
Deep brain stimulation (DBS) of the internal globus pallidus (Gpi) is an effective therapy for various types of dystonia. The authors describe their technical approach for securing appropriate placement of the stimulating electrodes within the Gpi under general anaesthesia, including MRI based individualised anatomical targeting combined with electrophysiological mapping of the Gpi using micro-recording (MER) as well as macrostimulation and report the subsequent clinical outcome and complications using this method. ⋯ The described technique using stereotactic MRI for planning of the trajectory and direct visualisation of the target, intra-operative MER for delineating the boundaries of the target and macrostimulation for probing the distance to the internal capsule by identifying the threshold for stimulation induced tetanic contractions is effective in DBS electrode implantation in patients with dystonia operated under general anaesthesia. The central trajectory was chosen in only 64%, despite individual adaptation of the target due to direct visualisation of the Gpi in inversion recovery MRI in 43% of the patients, demonstrating the necessity of combining anatomical with neurophysiological information.
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Having just celebrated the centenary of the first transsphenoidal pituitary operation by (Schloffer in Austria in Beitr Klin Chir 50:767-817, 1906), and this year the quarter centenary of the first published report of a therapeutic use of the neuroendoscope (for colloid cysts of the third ventricle) (Powell et al. in Neurosurgery 13:234-237, 1983), it is time to consider the relative merits of microscopic and endoscopic approaches for pituitary surgery. Although transsphenoidal endoscopic surgery has only been utilised by pioneers such as Jho since the mid-1990s (Jho et al., 1996), there is no doubt that it has already gained an important place in the neurosurgical armamentarium, but there is both confusion and propaganda about which method of surgery has most to offer, and indeed whether or not there is any real difference at all.
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Acta neurochirurgica · Jul 2009
Skull base chordomas: efficacy of surgery followed by carbon ion radiotherapy.
Skull base chordomas are challenging to treat because of their invasive nature, critical location, and aggressive recurrence. We report the effectiveness of combined radical skull base surgery with carbon ion radiotherapy for treating skull base chordomas. ⋯ Surgical removal of the tumour around the brainstem and the optic nerve combined with post-operative carbon ion radiotherapy will improve the survival rate and quality of life of patients with complicated skull base chordomas.
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Acta neurochirurgica · Jul 2009
Case ReportsTransarterial coil embolization of a carotid-cavernous fistula which occurred during stent angioplasty.
Intracranial endovascular procedures are less invasive and relatively safe; however, these procedures do carry a risk of complications, such as thromboembolization, arterial injury, and vessel occlusion. We present a case of carotid-cavernous fistula development secondary to injury of the cavernous segment of the internal carotid artery (ICA) during stent angioplasty and its treatment by transarterial coil embolization. Probable causes of this complication and its treatment method are discussed. To the best of our knowledge, this is the first report of such a case.