Acta neurochirurgica
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Acta neurochirurgica · Dec 2011
ReviewExpanding applications of deep brain stimulation: a potential therapeutic role in obesity and addiction management.
The indications for deep brain stimulation (DBS) are expanding, and the feasibility and efficacy of this surgical procedure in various neurologic and neuropsychiatric disorders continue to be tested. This review attempts to provide background and rationale for applying this therapeutic option to obesity and addiction. We review neural targets currently under clinical investigation for DBS—the hypothalamus and nucleus accumbens—in conditions such as cluster headache and obsessive-compulsive disorder. These brain regions have also been strongly implicated in obesity and addiction. These disorders are frequently refractory, with very high rates of weight regain or relapse, respectively, despite the best available treatments. ⋯ Well-designed pilot studies and clinical trials enrolling carefully selected patients with obesity or addiction should be initiated.
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Acta neurochirurgica · Dec 2011
Comparative StudyStudy of dural suture watertightness: an in vitro comparison of different sealants.
CSF leakages constitute a major complication of intradural procedures, especially for posterior fossa and skull base surgery. Dural suture watertightness is a decisive issue, and neurosurgeons routinely use different products to reinforce their dural closure. We have designed an experimental system capable of testing CSF leak pressure levels in order to compare two types of sutures in vitro and particularly four different sealants. ⋯ We have developed an experimental device capable of testing dural closure watertightness. Interrupted stitch suturing seemed no different from running simple closure. On the contrary, the sealants tested show different watertightness capacities.
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Acta neurochirurgica · Dec 2011
Case ReportsResection of an inferior pontine cavernous malformation using a far-lateral transcondylar approach.
When considering an approach to remove a symptomatic brainstem cavernous malformation, exposure and adequate visualization of the lesion with minimal morbidity should be the primary goals. ⋯ We recommend adding this technique to the repertoire of approaches used to resect these technically challenging lesions in selected cases.
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Pituitary surgery is a recent development in neurosurgery and most of the surgical techniques concerned have been described within the last century. We provide a historical perspective by reviewing the major steps in the development of this neurosurgical subspecialty through the ages. We concentrate on the most important figures whose advances in the study of the physiology and anatomy of the pituitary are most significant. This journey into the past will demonstrate that our current knowledge is the summation of a long road of investigation.