Journal of neurosurgery
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Journal of neurosurgery · Sep 2003
Case ReportsCombined transvenous and transarterial embolization of a tentorial-incisural dural arteriovenous malformation followed by primary stent placement in the associated stenotic straight sinus. Case report.
Dural arteriovenous malformations (AVMs) involving the tentoria-incisura are associated with an aggressive clinical course characterized by subarachnoid and intracranial hemorrhage (ICH). In these lesions, venous outflow obstruction precipitates leptomeningeal venous drainage, resulting in the arterialization of pial veins and the formation of venous aneurysms, both of which are prone to hemorrhage. Stenotic lesions of the dural sinuses also contribute to the development of retrograde leptomeningeal drainage, which is responsible for the aggressive clinical course of the dural AVM. ⋯ A combined transvenous and transarterial embolization procedure was performed, resulting in complete obliteration of the dural AVM, followed by primary stent placement across a stenotic segment of the straight sinus and normalization of venous outflow. The authors conclude that dural AVMs can be treated safely by using a combined transarterial and transvenous approach and that an extensive search for venous outflow obstruction often reveals stenosis of a draining sinus. Consideration should be given to primary stent placement in the stenotic sinus to protect against ICH.
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Journal of neurosurgery · Sep 2003
Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease.
The use of deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been associated with a marked initial improvement in individuals with advanced Parkinson disease (PD). Few data are available on the long-term outcomes of this procedure, however, or whether the initial benefits are sustained over time. The authors present the long-term results of a cohort of 25 individuals who underwent bilateral DBS of the STN between 1996 and 2001 and were followed up for 1 year or longer after implantation of the stimulator. ⋯ In this group of patients with advanced PD who underwent bilateral DBS of the STN, sustained improvement in motor function was present a mean of 2 years after the procedure, and sustained reductions in drug requirements were also achieved. Improvements in tremor, rigidity, and bradykinesia were more marked and better sustained over time than improvements in axial symptoms. A good preoperative response to levodopa predicted a good response to surgery.
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Journal of neurosurgery · Sep 2003
Titanium mesh cages for cervical spine stabilization after corpectomy: a clinical and radiological study.
Reconstruction after anterior cervical decompression has involved the use of tricortical iliac crest bone or fibular strut grafts, but has been associated with significant morbidity. In this study the authors evaluated the efficacy of titanium mesh cages (TMCs) for stability and fusion following anterior cervical corpectomy. ⋯ Thirty-seven patients were prospectively evaluated during a 4-year period. The majority presented with spinal cord compression (97%) often due to cervical spondylosis (87%). The TMC was filled with iliac crest bone chips or Surgibone and stabilized by anterior cervical plates (ACPs). The changes in settling ratio, coronal and sagittal angles, and sagittal displacement were determined at 3, 6, and 12 months; immediate postoperative radiographs were used as baseline. Flexion-extension radiographs and computerized tomography (CT) scans (obtained at 1 year) were examined to assess stability, fusion, and bone growth within the TMC. Complications such as settling, telescoping, migration, and pseudarthrosis were not observed. Dynamic radiography revealed spinal stability in all patients. Cage-related complications occurred in 2.7% (TMC malplacement [one patient]), surgery-related complications in 10.8%, and graft-related complications in 21.6%. Evidence of bone growth into the TMC was documented in 16 (95%) of 17 patients on CT scans. The mean cage height-related settling rates were 4.46% at 3 months (31 patients [p = 0.066]), 3.89% at 6 months (28 patients [p = 0.028]), and 4.35% at 1 year (27 patients [p = 0.958]). The mean sagittal displacement changed by 3.9% (23 patients [p = 0.73]). The mean coronal and sagittal angles changed 2.89 degrees (30 patients [p = 0.498]) and 2.09 degrees (29 patients [p = 0.001]) at 1 year, respectively, or at last follow up from baseline. No significant differences in the radiological indices were seen when multilevel vertebrectomy cases were compared with single-level vertebrectomy (p = 0.221), smoking status, or age. Conclusions. Titanium mesh cages, in combination with ACPs, are safe and effective for vertebral replacement in the cervical spine.
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Journal of neurosurgery · Sep 2003
Comparative StudyPedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion?
Posterolateral fusion involving instrumentation-assisted segmental fixation represents a valid procedure in the treatment of lumbar instability. In cases of anterior column failure, such as in isthmic spondylolisthesis, supplemental posterior lumbar interbody fusion (PLIF) may improve the fusion rate and endurance of the construct. Posterior lumbar interbody fusion is, however, a more demanding procedure and increases costs and risks of the intervention. The advantages of this technique must, therefore, be weighed against those of a simple posterior lumbar fusion. ⋯ The authors' findings support the view that an interbody fusion confers superior mechanical strength to the spinal construct; when posterolateral fusion is the sole intervention, progressive loss of the extreme correction can be expected. Such mechanical insufficiency, however, did not influence clinical outcome.
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Journal of neurosurgery · Sep 2003
Prevention of postoperative posterior tethering of spinal cord after resection of ependymoma.
The authors evaluated an alternative method to avoid postoperative posterior tethering of the spinal cord following resection of spinal ependymomas. ⋯ This new technique for closure of the surgical wound is effective in preventing of postoperative posterior spinal cord tethering after excision of spinal ependymoma.