Journal of neurosurgery
-
Journal of neurosurgery · Jan 2004
Microsurgical interlaminary vertebro- and kyphoplasty for severe osteoporotic fractures.
Percutaneous vertebro- and kyphoplasty have become established methods for the treatment of uncomplicated osteoporotic vertebral fractures. In the setting of severe fractures involving fragmentation of the posterior wall and neural compromise, however, decompressive surgery cannot be performed and epidural cement leakage is poorly controlled. A microsurgical interlaminary approach for vertebro- and kyphoplasty was developed to allow spinal decompression and control of the spinal canal during augmentation. ⋯ The present microsurgical interlaminary approach for vertebro- and kyphoplasty enables treatment of severe osteoporotic fractures involving fragmentation of the posterior wall and neural compromise. Decompressive surgery is possible and the risk of epidural cement leakage is controlled intraoperatively. This technique can be regarded as a procedure on the treatment continuum between percutaneous augmentation and conventional open reconstruction.
-
Journal of neurosurgery · Jan 2004
Delayed neurological deficits detected by an ischemic pattern in the extracellular cerebral metabolites in patients with aneurysmal subarachnoid hemorrhage.
In the treatment of patients with aneurysmal subarachnoid hemorrhage (SAH), early occlusion of the aneurysm is necessary as well as monitoring and treatment of complications following the primary bleeding episode. Monitoring with microdialysis has been studied for its ability to indicate and predict the occurrence of delayed ischemic neurological deficits (DINDs) in patients with SAH. ⋯ Microdialysis monitoring of the cerebral metabolism in patients with SAH may predict with high sensitivity and specificity the occurrence of a DIND. Whether an earlier diagnosis results in better treatment of DINDs and, therefore, in overall better outcomes remains to be proven, as it is linked to an efficacious treatment of cerebral vasospasm.
-
Journal of neurosurgery · Jan 2004
Surgical treatment of symptomatic Rathke cleft cysts: clinical features and results with special attention to recurrence.
Rathke cleft cysts (RCCs) are rarely symptomatic. The purpose of this study was to clarify the clinical, neuroimaging, surgical, and pathological features of symptomatic RCCs with special attention to their recurrence. ⋯ Rathke cleft cysts are associated with a variety of clinical presentations and sometimes confusing intraoperative and pathological findings. Close postoperative observation with neuroimaging and neuroophthalmological assessment is necessary, especially after a partial removal, as in cases with squamous metaplasia.
-
Journal of neurosurgery · Jan 2004
Case ReportsTraumatic aneurysm of the supraclinoid internal carotid artery and an associated carotid-cavernous fistula: vascular reconstruction performed using intravascular implantation of stents and coils. Case report.
This report documents the treatment of a traumatic aneurysm of the supraclinoid internal carotid artery (ICA) that was associated with a carotid-cavernous fistula (CCF), which appeared following closed head trauma. This life-threatening lesion, which is very rare, required aggressive management achieved using intravascular stents and coils. A 19-year-old man presented with severe traumatic intracerebral and subarachnoid hematoma after he had suffered a severe closed head injury in a motor vehicle accident. ⋯ Follow-up angiography obtained 7 months postoperatively revealed persistent obliteration of the aneurysm and CCF as well as patency of the parent artery. The patient remained asymptomatic during the clinical follow-up period of 14 months. Endovascular treatment involving the use of a stent combined with coils appears to be a feasible, minimally invasive option for treatment of this hard-to-treat lesion.
-
Journal of neurosurgery · Jan 2004
Case ReportsTransvertebral interbody cage and pedicle screw fixation for high-grade spondylolisthesis. Case report.
Surgical stabilization of high-grade lumbosacral spondylolisthesis is clinically challenging, and the success of deformity reduction and fusion varies. The authors describe a patient with Grade III spondylolisthesis at L5-S1. Partial reduction was achieved and fusion involved pedicle screw fixation and a posterior transvertebral interbody cage. ⋯ Clinical and early radiographic results were excellent. Transsacral cage fixation can be considered a viable option to buttress the region in which high-grade L5-S1 spondylolisthesis has been reduced. The cage provides substrate for interbody arthrodesis and acts as a biomechanical stabilizer that helps prevent pedicle screw failure.