Acta neurochirurgica
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Acta neurochirurgica · Jan 2015
Delayed relief of hemifacial spasm after microvascular decompression: can it be avoided?
Although microvascular decompression (MVD) surgery has been widely accepted as an effective treatment for hemifacial spasm (HFS), delayed relief cases have been frequently reported. Therefore, the value of an immediate redo MVD should be discussed. ⋯ Despite being a reasonable remedy for HFS in the hands of an experienced neurosurgeon, sometimes small vessels can be missed while managing the main offending arteries during MVDs, which might account for the delayed relief. Therefore, reexamination of the AMR is necessary for unimproved patients; if a positive result is recorded, an immediate redo MVD is suggested.
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Occipital nerve stimulation is increasingly used in the treatment of primary headache disorders. We describe a surgical technique applying preoperative fluoroscopy and intraoperative tactile orientation designed to reduce radiation exposure and provide reproducible results. ⋯ The use of tactile orientation solely during surgery reduces radiation exposure and decreases the duration of surgery. This technique allows reproducible results of final electrode position.
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Acta neurochirurgica · Jan 2015
Influence of cumulative surgical experience on the outcome of poor-grade patients with ruptured intracranial aneurysm.
The expansion of endovascular techniques for intracranial aneurysms has led to a global decrease in vascular neurosurgery activity. This situation might impact neurosurgeons' level of expertise, even though they all might have to deal with this surgically challenging pathology. In that context, we wanted to assess the impact of cumulative surgical experience on the outcome of patients with poor-grade subarachnoid haemorrhage (SAH) and intracerebral haemorrhage (ICH) treated by microsurgery. ⋯ This study suggests a direct impact of cumulative experience on the course of ruptured aneurysm surgery and pleads for the use of training and simulation programmes dedicated to neurovascular surgery.