Acta neurochirurgica
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Acta neurochirurgica · Jun 2010
Percutaneous approach to the foramen ovale: an anatomical study of the extracranial trajectory with the incorrect trajectories to be avoided.
Meckel's Cave may be accessed percutaneously through the foramen ovale (FO). Detailed knowledge of the region's anatomical surroundings is invaluable in improving target accuracy and preventing complications with this approach. The approach has been used in the treatment of trigeminal neuralgia as well as in performing biopsies of lesions located in the parasellar region, described formerly by the senior author (M.S.). A comprehensive cadaveric study of the region traversed by needle is thus presented. ⋯ Although widely used, the FO approach carries risks. Special attention is warranted when the needle traverses the upper third of the pyramid to avoid the variant course of the MA. Image-guided techniques and detailed anatomical knowledge are necessary to expand the use of this route not just for approach to lesions within the parasellar and upper third of the petroclival region but also to lesions invading the infratemporal fossa.
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Acta neurochirurgica · Jun 2010
Flow replacement bypass for aneurysms: decision-making using intraoperative blood flow measurements.
There is much debate regarding the optimal strategy for extracranial-intracranial (EC-IC) bypass for complex aneurysms. We introduce the concept of a flow replacement bypass which aims to compensate for loss of flow in the efferent vessels of the aneurysm. The strategy to achieve this utilizes direct intraoperative flow measurements to guide optimal revascularization by matching graft flow to demand. ⋯ Direct intraoperative measurement of flow deficit in aneurysm surgery requiring parent vessel sacrifice can guide the choice of flow replacement graft and confirm the subsequent adequacy of bypass flow.
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Acta neurochirurgica · Jun 2010
Transcranial color-coded duplex sonography allows to assess cerebral perfusion pressure noninvasively following severe traumatic brain injury.
Assess optimal equation to noninvasively estimate intracranial pressure (eICP) and cerebral perfusion pressure (eCPP) following severe traumatic brain injury (TBI) using transcranial color-coded duplex sonography (TCCDS). ⋯ TCCDS-based equation (ICP = 10.927 x PI - 1.284) allows to screen patients at risk of increased ICP and decreased CPP. However, adequate therapeutic interventions need to be based on continuously determined ICP and CPP values.
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Acta neurochirurgica · Jun 2010
Case ReportsDecompressive craniectomy for neurotrauma: the limitations of applying an outcome prediction model.
There is currently much interest in the use of decompressive craniectomy for patients with severe head injury. A number of studies have demonstrated that not only can the technique lower intracranial pressure but can also improve outcome. Whilst many patients who would otherwise have died or had a poor outcome now go on to make a good recovery, there is little doubt that complications can have a very significant impact on long term outcome. ⋯ This report illustrates the potential clinical applications and limitations of an outcome prediction model and demonstrates the impact that complications can have on eventual outcome.
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Acta neurochirurgica · Jun 2010
The combination of semi-sitting position and intraoperative MRI--first report on feasibility.
Intraoperative MRI (iMRI) has been established as a routine imaging modality with a remarkable impact on specific neurosurgical procedures. The technological advancement continuously extends the spectrum of iMRI, leading to an increasing number of installations. Yet, procedures in which a semi-sitting position would be advantageous were beyond the reach of iMRI. ⋯ This report demonstrates for the first time that the combination of iMRI and the semi-sitting position is feasible and that this procedure bears specific benefits. Issues such as brain shift due to table tilting warrant further investigations in order to expand this technique to posterior fossa craniotomies.