Journal of neurosurgery
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Journal of neurosurgery · Jan 2006
Clinical TrialCerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression.
The use of decompressive craniectomy has experienced a revival in the previous decade, although its actual benefit on patients' neurological outcome remains the subject of debate. A better understanding of the intracranial pressure dynamics, as well as of the metabolic and hemodynamic brain processes, may be useful in assessing the effect of this surgery on the pathophysiology of the swollen brain. The aim of this study was to use transcranial Doppler (TCD) ultrasonography to examine the hemodynamic changes in the brain after decompressive craniectomy in patients with head injury, in addition to examining the relationship between such hemodynamic changes and the patient's neurological outcome. ⋯ Decompressive craniectomy results in a significant elevation of cerebral BFV in most patients with traumatic brain swelling and transtentorial herniation syndrome. The increase in cerebral BFV may also occur in the side opposite the decompressed hemisphere; the cerebral BFV increase is significantly greater in the operated hemisphere than contralaterally. Concomitantly, PI values decrease significantly postoperatively, mainly in the decompressed cerebral hemisphere, indicating reduction in cerebrovascular resistance.
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Journal of neurosurgery · Jan 2006
Case ReportsEndoscopic aqueductoplasty and placement of a stent in the cerebral aqueduct in the management of isolated fourth ventricle in children.
In this study the authors conducted a retrospective evaluation of the effectiveness of endoscopic aqueductoplasty, performed alone or accompanied by placement of a stent, in the treatment of an isolated fourth ventricle (IFV) in seven patients afflicted with loculated hydrocephalus after a hemorrhage or infection. ⋯ Endoscopic placement of a stent in the aqueduct is more effective in preventing the repeated occlusion of the aqueduct than aqueductoplasty alone and should be indicated as the initial treatment in each case of compatible anatomy.
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Journal of neurosurgery · Jan 2006
Custom-tailored transdural anterior transpetrosal approach to ventral pons and retroclival regions.
The extradural anterior petrosectomy approach to the pons and midbasilar artery (mid-BA) has the main disadvantage that the extent of resection of the petrous apex cannot be as minimal as desired given that the surgical target field is not visible during bone removal. Unnecessary or excessive drilling poses the risk of injury to the internal carotid artery, vestibulocochlear organ, and seventh and eighth cranial nerves. The use of a custom-tailored transdural anterior transpetrosal approach can potentially avoid these pitfalls. ⋯ The custom-made transdural anterior petrosectomy appears to be a feasible alternative to the formal extradural approach.
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Journal of neurosurgery · Jan 2006
Case ReportsPediatric atlantoaxial fixation with bilateral, crossing C-2 translaminar screws. Technical note.
The authors describe the cases of three children in whom atlantoaxial instability was caused by os odontoideum, all requiring surgical fixation. Although C1-2 rod/cantilever constructs involving C-2 pedicle screws and C1-2 transarticular screws have been widely applied in adults, only C1-2 transarticular screw fixation has been reported in children. ⋯ Atlantoaxial fixation with C-2 translaminar screws has recently been reported in adult cases in which the risk of VA injury was reduced. The authors report the successful results of rigid atlantoaxial fixation in three children in whom bilateral crossing C-2 translaminar screws were placed, and they discuss the possible advantages of this technique in the pediatric population.
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Journal of neurosurgery · Jan 2006
Case ReportsApplication of computer-assisted design in craniofacial reconstructive surgery using a commercial image guidance system. Technical note.
The technology of digital image guidance systems has transformed many aspects of neurosurgery, including intracranial tumor surgery, functional neurosurgery, and spinal surgery. Despite the central role of imaging studies in diagnosis and treatment planning, intraoperative image guidance has so far had very limited application to the surgical correction of craniofacial deformities, particularly those associated with craniosynostosis. The authors report an example of the marriage of computer-assisted design methods to a commercially available neurosurgical image-guidance system in the treatment of a case of anterior plagiocephaly due to unilateral coronal synostosis. They discuss the steps that must yet be taken to make this technology applicable to the management of craniosynostosis in infants.