Acta neurochirurgica
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Acta neurochirurgica · Oct 2010
Outcome predictors of percutaneous endoscopic lumbar discectomy and thermal annuloplasty for discogenic low back pain.
Endoscopic discectomy with annuloplasty is considered as a novel minimally invasive technique for treating chronic discogenic low back pain (DLBP). The purpose of this study was to evaluate the outcome predictors and to describe technical aspects for endoscopic solutions against DLBP. ⋯ PELDTA may be effective for patients with chronic DLBP in selected cases. Central disc herniation causing DLBP was the most important predictor for clinical success.
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Acta neurochirurgica · Oct 2010
Comparative StudyDysembryoplastic neuroepithelial tumors and gangliogliomas: clinical results of 52 patients.
Dysembryoplastic neuroepithelial tumors (DNET) and gangliogliomas (GG) are generally associated with epilepsy in young patients. Presurgical work-up and postsurgical results vary from center to center. Seizures are commonly focal with secondary generalization, and surgical treatment is often effective. ⋯ Our results indicate that a prompt diagnosis and total resection with additional adjacent structures or cortices when feasible are associated with a high epilepsy cure rate. Not only children but also adults benefit from surgical treatment. Although radiological features of DNETs or GGs are helpful, no definitive differences were found between the two types of tumors. Thus, clinical, radiological, and histopathological findings have to be considered together.
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Acta neurochirurgica · Oct 2010
Case ReportsPostauricular, transpetrous, presigmoid approach for extensive skull base tumors in the petroclival region: the successes and the travails.
Postauricular, transpetrous, presigmoid approach combines a supra/infratentorial exposure with partial petrosectomy to access third to the twelfth cranial nerves and extraaxial lesions situated anterolateral to brainstem. It provides a shorter working distance to large petrosal, petroclival, cerebellopontine, and cerebellomedullary cisternal lesions and their extensions to the subtemporal-infratemporal areas. This study reviews the surgical technique, corridors of extension, and complications encountered utilizing this approach for excising extensive lesions in these locations. ⋯ The approach facilitates direct tumor decompression and its retraction away from the brainstem without initially encountering the intracisternal cranial nerves and neuraxis. It provides multiple corridors for excising extensive posterior fossa tumors. Preoperative assessment of sigmoid sinus dominance, jugular bulb height, labyrinth, vein of Labbe, and space available through Trautman's triangle considerably helps in complication avoidance.
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Acta neurochirurgica · Oct 2010
Case ReportsTentorial dural fistula with giant venous ampulae treated with embolisation and surgery. A case report.
Tentorial dural arteriovenous fistulas are rare and complex lesions in deep locations with unusual vascular anatomy and critical surrounding neuroanatomy. A rare case presenting a complex fistula with a giant venous draining ampulae, causing headaches and visual troubles is presented. We describe the case of a 52-year-old woman admitted in our department for headaches and visual troubles. ⋯ Our report describes an unusual case of a tentorial dural complex fistula treated by an endovascular procedure with secondary clinical aggravation that needed emergent surgical therapy. Even in a case for good immediate radiological result after endovascular procedure, dural arteriovenous fistulas with giant venous ampulae and important venous engorgement, need closed follow-up, because of the possibility of aggravation secondary to venous thrombosis and haemorrhage. Treatment and patophysiology of the aggravation mechanism are discussed.
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Acta neurochirurgica · Oct 2010
Slow vasogenic fluctuations of intracranial pressure and cerebral near infrared spectroscopy--an observational study.
Increased slow-wave activity in intracranial pressure (ICP) signifies an exhausted cerebrospinal compensatory reserve across a range of conditions. In this study, we attempted to describe synchronisation between slow waves of ICP and of near-infrared spectroscopy (NIRS) variables during controlled elevation of ICP. ⋯ Slow fluctuations in cerebral oximetry as detected by NIRS coincide with and are implicated in the origin of ICP slow waves and increases during periods of exhausted cerebrospinal compensatory reserve. NIRS may be used as a non-invasive marker of increased ICP slow waves (and therefore reduced CSF compensatory reserve).