Journal of neurosurgery
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Journal of neurosurgery · Jun 2009
Morbidity in epilepsy surgery: an experience based on 2449 epilepsy surgery procedures from a single institution.
In this paper the authors aimed to provide information related to major and minor surgical and neurological complications encountered following stereoelectroencephalography and epilepsy surgery.Methods The authors performed a retrospective review of 491 and 1905 patients who underwent intracranial electrode implantation and epilepsy surgery, respectively, between 1976 and 2006 at the Montreal Neurological Institute. All intracranial electrode implantations and surgical procedures were performed by 1 surgeon (A.O.). ⋯ Based on the authors' experience, intracranial electrode implantation is an effective method with an extremely low morbidity rate. Moreover, epilepsy surgery is safe, especially in experienced hands.
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The insular region has long been neglected in the investigation and treatment of refractory epilepsy. Surgery in the insular region is rarely performed because of the risk of injury to the opercula, the arteries transiting on the surface of the insula, and the deep structures such as the basal ganglia and the internal capsule. This study was undertaken to report the results of insular surgery using modern microsurgical techniques in patients with epilepsy. ⋯ Insular surgery is both safe and beneficial when it is well planned and performed with modern microsurgical techniques and good anatomical knowledge. Insulectomy is associated with little permanent morbidity and a high rate of seizure control. To the authors' knowledge, this is the first series of insulectomies predominantly performed for refractory epilepsy since those performed by Penfield.
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Journal of neurosurgery · Jun 2009
Safe entry point for twist-drill craniostomy of a chronic subdural hematoma.
Twist-drill craniostomy (TDC) with closed-system drainage is an effective treatment option for chronic subdural hematoma (CSDH). Because the entry point for TDC has not been described in a definitive area, the aim of this study was to define the optimal twist-drill entry point for CSDH. ⋯ One centimeter anterior to the coronal suture at the level of the STL is suitable as the normal entry point of the TDC for symptomatic CSDH. The thickness of the CSDH can be measured at this point on a preoperative brain CT scan. Furthermore, the entry point on the scalp can be accurately estimated using surface landmarks.
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Journal of neurosurgery · Jun 2009
Clinical evaluation of the safety and efficacy of lumbar cerebrospinal fluid drainage for the treatment of refractory increased intracranial pressure.
Several approaches have been established for the treatment of intracranial hypertension; however, a considerable number of patients remain unresponsive to even aggressive therapeutic strategies. Lumbar CSF drainage has been contraindicated in the setting of increased intracranial pressure (ICP) because of possible cerebral herniation. The authors of this study investigated the efficacy and safety of controlled lumbar CSF drainage in patients suffering from intracranial hypertension following severe traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (SAH). ⋯ Lumbar drainage of CSF led to a significant and clinically relevant reduction in ICP. The risk of cerebral herniation can be minimized by performing lumbar drainage only in cases with discernible basal cisterns.
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Journal of neurosurgery · Jun 2009
Stability of symptom control after replacement of impulse generators for deep brain stimulation.
Impulse generators (IPGs) for deep brain stimulation (DBS) need to be replaced when their internal batteries fail or when technical problems occur. New IPGs are routinely programmed with the previous stimulation parameters. In this study, the authors evaluate the stability of symptom control after such IPG replacements. ⋯ Replacement of the IPG requires careful follow-up of patients with DBS to ensure stable symptom control.