Journal of neurosurgery
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Journal of neurosurgery · Nov 2010
Case ReportsHigh-definition fiber tracking guidance for intraparenchymal endoscopic port surgery.
The authors have applied high-definition fiber tracking (HDFT) to the resection of an intraparenchymal dermoid cyst by using a minimally invasive endoscopic port. The lesion was located within the mesial frontal lobe, septal area, hypothalamus, and suprasellar recess. Using high-dimensional (256 directions) diffusion imaging, more than 250,000 fiber tracts were imaged before and after surgery. ⋯ The observed fiber preservation from the cingulum and the anterior limb of the internal capsule, with minor injury to the corpus callosum, was in close agreement with preoperative trajectory modeling. Comparison of pre- and postoperative HDFT data facilitated quantification of the benefits and costs of the surgical trajectory. Future studies will help to determine whether HDFT combined with endoscopic port surgery facilitates anatomical and functional preservation in such challenging cases.
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Journal of neurosurgery · Nov 2010
Case ReportsUse of confirmatory imaging studies to illustrate adequate treatment of cerebrospinal fluid leak in spontaneous intracranial hypotension.
Spontaneous intracranial hypotension (SIH) is a syndrome with serious neurological sequelae. As demonstrated by the following report, recurrent episodes of SIH can be difficult to diagnose when associated with other neurosurgical procedures, such as craniectomies. In this paper, the authors demonstrate SIH presenting as a subdural hematoma with recurrence of CSF leaks. ⋯ Treatment of SIH necessitated multiple epidural blood patches for CSF leaks at different spinal levels and at different times. The efficacy of each epidural blood patch was confirmed with radionuclide imaging. Confirmation of effective blood patch placement may be useful for identifying patients at risk for a failed epidural blood patch or for patients whose neurological examination results have not fully improved.
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Journal of neurosurgery · Nov 2010
Effectiveness of an epidural blood patch for patients with intracranial hypotension syndrome and persistent spinal epidural fluid collection after treatment.
Magnetic resonance imaging may show a fluid collection in the spinal epidural space of patients with spontaneous intracranial hypotension syndrome (SIHS), but the chronological changes remain unclear. ⋯ An epidural blood patch is effective for sealing of CSF leaks, but the resolution of SIHS-related symptoms does not always imply complete eradication of the leakage.
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Journal of neurosurgery · Nov 2010
Comparative StudyImage-guided anatomical and morphometric study of supraorbital and transorbital minicraniotomies to the sellar and perisellar regions: comparison with standard techniques.
Minimally invasive approaches have been proposed for the treatment of anterior cranial base pathology. Whereas earlier studies have quantified surgical exposure by referring to the opening on the surface, this cadaveric morphometric study redefines the concept of working area by examining the deep exposures afforded by several different approaches. Specifically, the authors systematically quantify and compare the operative exposure afforded by the pterional, supraorbital, and transorbital keyhole approaches to the sellar, suprasellar, and perisellar regions, including the anterior communicating artery complex. ⋯ In refining the concept of working area as deep rather than superficial in the surgical field, the authors quantified the 6 triangles whose boundaries were relative to the target structures to be exposed in the approach. The authors' morphometric findings support the use of the supraorbital and transorbital approaches as a valid alternative to the pterional approach for the treatment of sellar and perisellar pathology. The transorbital approach combines the advantages of minimal invasiveness with those of cranial base techniques.
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Journal of neurosurgery · Nov 2010
The clinical significance and optimal timing of postoperative computed tomography following cranial surgery.
This study was conducted to evaluate the value of postoperative CT scans in determining the probability of return to the operating room (OR) and the optimal time to obtain such scans to determine the effects of surgery. ⋯ Routine postoperative scans at 0-7 hours or at 8-24 hours are not predictive of return to the OR, whereas patients with a new neurological deficit in the postoperative period have a 30% chance of emergency reoperation based on CT scans. In addition, early postoperative scans (0-7 hours) fail to predict CT changes, which might evolve over time and may influence postoperative medical management.