Acta neurochirurgica
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First introduced by Pimenta et al. in 2001, the extreme lateral interbody fusion (XLIF®) approach is a safe and effective alternative to anterior or posterior approaches to lumbar fusion, avoiding the large anterior vessels and posterior structures including the paraspinous muscles, facet joint complexes and tension bands. ⋯ • Correct lateral positioning with an orthogonal orientation of the corresponding lumbar vertebral body is of key importance. • Subsequent table repositioning for every level is advised in multilevel cases. • Posterior structures including the paraspinous muscles, facet joint complexes and tension bands are mostly preserved. • Meticulous preoperative planning of the psoas docking point, considering all level-specific vascular and neuronal elements, is of paramount importance. • In general, concavity is recommended for the selection of the approach side. • A careful endplate and contralateral preparation and release are mandatory in order to allow bony fusion and maximum indirect foraminal decompression. • Using a perioperative dexamethasone bolus seems to be effective at the L4/5 level to reduce postoperative plexopathy. • Overdistraction should be avoided in order to prevent cage subsidence. • A major disadvantage is the relatively high, but mostly only transient, incidence of psoas weakness as well as hip-groin-thigh pain, dysaesthesia and/or numbness. • Major advantages include indirect neurological decompression, minimal blood loss, shorter operation times, decreased overall infection rates and more surface for bony fusion.
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Acta neurochirurgica · Mar 2015
Updated periodic evaluation of standardized neurointensive care shows that it is possible to maintain a high level of favorable outcome even with increasing mean age.
Periodic evaluation of neurointensive care (NIC) is important. There is a risk that quality of daily care declines and there may also be unrecognized changes in patient characteristics and management. The aim of this work was to investigate the characteristics and outcome for traumatic brain injury (TBI) patients in the period 2008-2009 in comparison with 1996-1997 and to some extent also with earlier periods. ⋯ A large-proportion favorable outcome was maintained despite that patients >60 years with poorer prognosis doubled, indicating that the quality of NIC has increased or at least is unchanged. More surgery may have contributed to maintaining the large proportion of favorable outcome. For future improvements, more knowledge about TBI management in the elderly is required.
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Acta neurochirurgica · Mar 2015
Burr hole is not burr hole: technical considerations to the evacuation of chronic subdural hematomas.
The organization of a multicenter survey about chronic subdural hematomas has triggered the discussion on different surgical techniques of burr hole evacuation. Such a standard operation gives neurosurgeons plenty of scope for creating their own way. ⋯ We present a thorough summary that could serve as a common standard and as a basis for comparison of future trials.
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Acta neurochirurgica · Mar 2015
Comparative StudyAccuracy of subthalamic nucleus targeting by T2, FLAIR and SWI-3-Tesla MRI confirmed by microelectrode recordings.
Successful deep brain stimulation is mostly dependent on accurate positioning of the leads at the optimal target points. We investigated whether the identification of the subthalamic nucleus in T2-weighted 3-T MRI, fluid-attenuated inversion recovery 3-T MRI and susceptibility-weighted 3-T MRI is confirmed by intraoperative neurological microelectrode recording. ⋯ The susceptibility-weighted 3-T MRI-based subthalamic nucleus localization shows the best accuracy compared with T2-weighted and fluid-attenuated inversion recovery 3-T MRI. Therefore, the susceptibility-weighted 3-T MRI should be preferred for surgical planning when the operation procedure is performed under general anesthesia without microelectrode recordings.
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Acta neurochirurgica · Mar 2015
Comparative StudyComparison of indocyanine green fluorescent angiography to digital subtraction angiography in brain arteriovenous malformation surgery.
The potential utility of intraoperative microscope-integrated indocyanine green (ICG) fluorescence angiography in the surgery of brain arteriovenous malformations (AVMs) and evaluation of the completeness of resection is debatable. Postoperative catheter angiography is considered the gold standard. We evaluated the value of ICG and intraoperative catheter angiography in this setting. ⋯ Although ICG angiography is a helpful adjunct in the surgery of some brain AVMs, it's yield in detecting residual AVM nidus or shunt is low, especially for deep-seated lesions and higher grade AVMs. ICG angiography should not be used as a sole and/or reliable technique. High-resolution postoperative angiography must be performed in brain AVM surgery and remains the best test to confidently confirm complete AVM resection.