Journal of neurosurgery
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Journal of neurosurgery · Jul 2010
Comparative StudyCerebrospinal fluid shunt insertion: techniques of peritoneal catheter placement separate from abdominal fascial and peritoneal incisions.
Good abdominal wall closure is one of the basic surgical skills and is a common feature of almost all modern-day CSF shunt operations. The fact that some patients require multiple abdominal operations highlights the need for a simple and effective technique for peritoneal catheter insertion through the abdominal wall and abdominal wall closure. ⋯ In this report, the authors describe a simple technique for passing the peritoneal catheter of a ventriculoperitoneal shunt through the abdominal wall on a pathway separate from the fascial opening. This technique minimizes the risk of abdominal wall-related complications and is especially important in high-risk patients such as those with obesity and/or diabetes and in children.
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Journal of neurosurgery · Jul 2010
Stereotactic radiosurgery for symptomatic solitary cerebral cavernous malformations considered high risk for resection.
A retrospective study was conducted to reassess the benefit and safety of stereotactic radiosurgery (SRS) in patients with solitary cerebral cavernous malformations (CCMs) that bleed repeatedly and are poor candidates for surgical removal. ⋯ Data in this study provide further evidence that SRS is a relatively safe procedure that reduces the rebleeding rate for CCMs located in high-surgical-risk areas of the brain.
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Journal of neurosurgery · Jul 2010
Comparative StudyGamma Knife radiosurgery for trigeminal neuralgia: the impact of magnetic resonance imaging-detected vascular impingement of the affected nerve.
Trigeminal neuralgia is believed to be related to vascular compression of the affected nerve. Radiosurgery has been shown to be reasonably effective for treatment of medically refractory trigeminal neuralgia. This study explores the rate of occurrence of MR imaging-demonstrated vascular impingement of the affected nerve and the extent to which vascular impingement affects pain relief in a population of trigeminal neuralgia patients undergoing Gamma Knife radiosurgery (GKRS). ⋯ Vascular impingement of the affected nerve was seen in the majority of patients with trigeminal neuralgia. Overall pain relief following GKRS was comparable in those with and without evidence of vascular compression on MR imaging. In subgroup analysis of those with MR imaging evidence of vessel impingement of the affected trigeminal nerve, pain relief correlated with a higher dose to the point of contact between the impinging vessel and the trigeminal nerve. Such a finding may point to vascular changes affording at least some degree of relief following GKRS for trigeminal neuralgia.