Journal of neurosurgery
-
Journal of neurosurgery · May 2011
Image-guided frameless stereotactic needle biopsy in awake patients without the use of rigid head fixation.
Image-guided frameless stereotactic techniques provide an alternative to traditional head-frame fixation in the performance of fine-needle biopsies. However, these techniques still require rigid head fixation, usually in the form of a head holder. The authors report on a series of fine-needle biopsies and brain abscess aspirations in which a frameless technique was used with a patient's head supported on a horseshoe headholder. To validate this technique, they performed an in vitro accuracy study. ⋯ The accuracy study demonstrated the ability of the mask to actively track the target and allow navigation to a 4-mm-diameter circular target with a 98% success rate. The frameless, pinless, fiducial-less technique described herein will likely be another safe, fast alternative to frame-based stereotactic techniques for fine-needle biopsy that avoids the potential morbidity of rigid head-pin fixation. Furthermore, it should lend itself to other image-guided applications such as the placement of ventricular catheters for shunting or Ommaya reservoirs.
-
Journal of neurosurgery · May 2011
Technique and outcome of endoscopy-assisted microscopic extended transsphenoidal surgery for suprasellar craniopharyngiomas.
The transcranial approach has been the standard technique for removal of craniopharyngiomas for several decades. However, many reports of successful suprasellar craniopharyngioma removal accomplished using extended transsphenoidal surgery (TSS) have recently been published. In the present study, the authors describe their technique and the outcomes of removal of suprasellar craniopharyngiomas aided by the use of an operating microscope and an endoscope concurrently during extended TSS. ⋯ The authors achieved good results by using extended TSS for the removal of suprasellar craniopharyngiomas. Endoscopy-assisted microscopic extended TSS harnesses the advantages of a microscope as well as those of an endoscope. Surgeons should consider using the advantages of both surgical modalities to achieve the best result possible.
-
Journal of neurosurgery · May 2011
Clinicopathological factors related to regrowth of vestibular schwannoma after incomplete resection.
The authors retrospectively analyzed various clinicopathological factors to determine which are related to regrowth during a long-term follow-up period in patients who underwent incomplete vestibular schwannoma (VS) resection. ⋯ Greater residual tumor thickness, based on MR imaging after the initial surgery, and a higher MIB-1 index are both important factors related to postoperative tumor regrowth in patients who have undergone incomplete VS resection. These patients require frequent neuroimaging investigation during follow-up to assure early detection of tumor regrowth.
-
Journal of neurosurgery · May 2011
Case ReportsPreservation of the superior petrosal sinus during the petrosal approach.
The petrosal approach is based on sectioning the superior petrosal sinus (SPS) and the tentorium. However, the venous anatomy in certain situations forbids this maneuver. The authors have derived a technique that enables the SPS to be spared during the performance of the petrosal approach. They describe the anatomical basis of this technique and report on 2 cases in which the technique was applied. ⋯ This modification of the petrosal approach involving sparing of the SPS or cutting of the tentorium is an effective means for cases in which the venous anatomy mandates preservation of these structures.