Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Jul 2013
Neuronavigation-assisted endoscopic unilateral cyst fenestration for treatment of symptomatic septum pellucidum cysts.
Traditional surgical treatments for this rare disease include open surgical procedures and ventriculoperitoneal shunting. In 1995, endoscopic fenestration was first applied to treatment of cysts of the septum pellucidum (CSP). However, cyst fenestration generally takes a bilateral approach by making two burr holes leading to two fenestrations in the lateral walls of the cyst. Some disadvantages are related to bilateral fenestration. So far, there is no consensus on the surgical indications, the endoscopic approaches, and techniques for CSPs. Based on our experience with 14 cases of symptomatic CSP treated with neuronavigation-assisted endoscopic unilateral cyst fenestration via a single burr hole, we discuss the operative indications and the utility of endoscope-assisted techniques in combination with neuronavigation. ⋯ The results after uni- and bilateral CSP fenestration show no significant difference. Avoiding damage of contralateral tissue, the surgical trauma in unilateral fenestration is less than in bilateral fenestration. Furthermore, the unilateral approach shortens the operation time. We believe that unilateral cyst fenestration is a better therapeutic option in symptomatic CSP.
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J Neurol Surg A Cent Eur Neurosurg · Jul 2013
Recurrence of lumbar disc herniation after microendoscopic discectomy.
Although microendoscopic discectomy (MED) is a minimally invasive surgical method for lumbar disc herniation (LDH), early postoperative recurrence may outweigh that advantage. The purpose of the present study was to retrospectively investigate the recurrence rate after MED for LDH and to determine the risk factors for recurrence in patients treated by a single surgeon. ⋯ The recurrence rate and reoperation rate for LDH after MED were comparable to those of conventional discectomy. More than half of the cases of recurrence occurred at an early postoperative phase, and patients with caudally migrated LDH experienced recurrence significantly more often than those with rostrally migrated or nonmigrated LDH.
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J Neurol Surg A Cent Eur Neurosurg · May 2013
Review Case ReportsPitfalls in brain death diagnosis: a case report.
Although there are distinct guidelines in nearly all countries, a reliable secure assessment of brain death in cases with open head injury can be challenging. We present a case of a 32-year-old man with severe head injury after intracranial penetration of a grindstone fragment. As the injury led to destruction of nearly the whole greater wing of the right sphenoid bone and parts of the right orbit, the examination of brainstem reflexes and the confirmation of brain death was unfeasible. ⋯ Referring to the actual German guidelines, we had no legitimating indication for a cerebral angiography. Finally, the patient died of sepsis. We discuss the widening of the German guidelines in assessing brain death with the fast and low-risk method of cerebral computed tomography-angiography (CTA) to confirm diagnosis of brain death.
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J Neurol Surg A Cent Eur Neurosurg · May 2013
Comparative StudyTransforaminal lumbar interbody fusion: comparison between open and mini-open approaches with two years follow-up.
Transforaminal lumbar interbody fusion (TLIF) is an efficient technique which can achieve a fusion rate of up to 90%. Minimally invasive approaches have become increasingly popular because they appear to minimize iatrogenic soft tissue and muscle injury. As minimally invasive TLIF gains popularity, its effectiveness compared with open TLIF has yet to be established. ⋯ The mini-open TLIF for symptomatic low-grade spondylolisthesis and degenerative disc disease is an effective option that achieves the same clinical and radiological outcomes at a minimum 2-year follow-up and reduces perioperative morbidity.
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J Neurol Surg A Cent Eur Neurosurg · May 2013
Case ReportsMini supraorbital approach to inferior frontal lobe cavernous malformations: case series.
Anterior surgical approaches to the inferior frontal lobe require large craniotomies with long incisions and some risk of cosmetic defects and surgical morbidity. A mini supraorbital keyhole approach is an alternative to these larger craniotomies. Inferior frontal lobe cavernous malformations are an excellent target for this minimally invasive approach, and we present our experience with two patients. ⋯ The mini supraorbital keyhole craniotomy with microsurgical technique and neuronavigation is an effective approach for treating cavernous malformations in the inferior frontal lobe. This minimally invasive approach reduces incision size, craniotomy size, and associated complications while enhancing cosmetic outcomes.