Journal of neurosurgery
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Journal of neurosurgery · Jul 2001
Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases.
In this report the author presents surgery-related outcomes after application of a new technique. A posterior microendoscopic laminoforaminotomy was used for the surgical treatment of unilateral cervical radiculopathy secondary to intervertebral disc herniations and/or spondylotic foraminal stenosis. The results of this procedure are compared with those achieved using traditional laminoforaminotomy and anterior cervical discectomy with or without fusion. ⋯ The microendoscopic posterior laminoforaminotomy is an effective alternative for the treatment of unilateral cervical radiculopathy secondary to lateral or foraminal disc herniations or spondylosis. In this group of patients, it is preferable because it does not require the sacrifice of a cervical motion segment, has a low incidence of complications, and is associated with a much quicker return to unrestricted full activity than that obtained with other techniques.
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Journal of neurosurgery · Jun 2001
Clinical and economic consequences of early discharge of patients following supratentorial stereotactic brain biopsy.
The goal of this study was to determine the clinical and economic consequences of early discharge (< 8 hours) of patients following stereotactic brain biopsy (SBB). ⋯ Early discharge of patients following SBB of supratentorial lesions is safe in the absence of excessive intraoperative bleeding, new postoperative deficit, and clot on a postoperative CT scan. Extended outpatient observation (8-23 hours) is not clinically necessary and may be economically prohibitive in the setting of a teaching hospital.
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The treatment of essential tremor with thalamic deep brain stimulation (DBS) is considered to be more effective and to cause less morbidity than treatment with thalamotomy. Nonetheless, implantation of an indwelling electrode, connectors, and a generator is associated with specific types of morbidity. The authors describe three patients who required revision of their DBS systems due to lead breakage. ⋯ The authors recommend that surgeons avoid placing the connection between the DBS electrode and the extension wire in the cervical region because patient movement can cause microfractures in the electrode. Such microfractures require intracranial revision, which may be associated with a higher risk of morbidity than the initial operation. The authors also recommend considering prophylactic relocation of the connectors from the cervical area to the subgaleal parietal region to decrease the risk of future DBS electrode fracture, which would necessitate a more lengthy procedure to revise the intracranial electrode.
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Journal of neurosurgery · May 2001
Case Reports Clinical TrialRole of bedside microdialysis in the diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
Ischemia due to vasospasm is a feared complication in patients following aneurysmal subarachnoid hemorrhage (SAH). Cerebral online microdialysis monitoring may detect the metabolic changes in the extracellular fluid associated with ischemia. The aims of the present study were to correlate clinical course, microdialysis-recorded data, transcranial Doppler (TCD) ultrasonography findings, and angiographic findings in patients with SAH. ⋯ Although angiography also demonstrates vessel narrowing in asymptomatic patients, online microdialysis reveals characteristic metabolic changes that occur during vasospasm. Thus, online microdialysis may be used to confirm the diagnosis of vasospasm.
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Journal of neurosurgery · May 2001
Clinical TrialThree-dimensional computerized tomography angiography-guided surgery of acutely ruptured cerebral aneurysms.
The aim of this study was to assess whether aneurysm surgery can be performed in patients with ruptured cerebral aneurysms by using three-dimensional computerized tomography (3D-CT) angiography alone, without conventional catheter angiography. ⋯ The authors believe that 3D-CT angiography can replace conventional angiography in the diagnosis of ruptured aneurysms and that surgery can be performed in almost all acutely ruptured aneurysms by using only 3D-CT angiography without conventional angiography.