Neurosurgery
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Comparative Study
Targeted brain biopsy: a comparison of freehand computed tomography-guided and stereotactic techniques.
With computed tomography (CT) and magnetic resonance imaging stereotactic systems, biopsies of intracranial lesions can be made with safety and ease. Before the development of this technique, neurosurgeons often performed freehand brain biopsies under CT guidance. While stereotactic biopsy is the procedure of choice for small, deep lesions, few studies have compared the morbidity, mortality, and efficacy in obtaining a diagnosis associated with these two techniques for superficial lesions. ⋯ Freehand CT-guided biopsy was associated with 5% morbidity, compared with 6% morbidity for stereotactic biopsy. Seven CT-guided needle biopsies (9%) and 12 stereotactic biopsies (18%) were nondiagnostic. Statistical analysis showed no significant difference between morbidity and mortality in the two groups, but the rate of diagnostic failure was significant (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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The actual site of excitation of the facial nerve by transcranial magnetic stimulation was investigated in five patients with hemifacial spasm who underwent microvascular decompression. The facial nerve was stimulated preoperatively and intraoperatively by transcranial magnetic stimulation and intraoperatively by electrical stimulation at its root exit zone with a minimum of surgical invasion of the facial nerves. ⋯ Therefore, transcranial magnetic stimulation was basically the same as electrical stimulation in onset latency. From this study, it appears that the root exit zone of the facial nerves is stimulated by transcranial magnetic stimulation.
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Comparative Study
Analgesia and sedation during percutaneous radiofrequency electrocoagulation for trigeminal neuralgia.
Patient comfort during percutaneous radiofrequency electrocoagulation for trigeminal neuralgia provides better working conditions for the surgeon and makes the patient more willing to return if a second procedure is necessary. This study evaluates five different regimens for analgesia and sedation including the standard of fentanyl and droperidol (Group A) and four other regimens, each containing midazolam. In a sixth group, droperidol was assessed for its antiemetic effects. ⋯ In another group of 96 patients, 1.25 mg of droperidol was given in addition to the medications described for Groups D and E. There was a statistically significant improvement in comfort in Groups C, D, and E and added amnesia in Groups D and E. Vomiting occurred in none of the patients medicated with droperidol and in 5 of 143 patients who did not receive droperidol.(ABSTRACT TRUNCATED AT 250 WORDS)
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A retrospective review of patients who underwent posterior cervical stabilization with Halifax Interlaminar Clamps in four neurosurgical centers in the United Kingdom was performed. Satisfactory bone fusion without complication occurred in all patients in whom lower cervical spinal stabilization (C3-C7) was performed. ⋯ In 10 patients, one of the screws loosened, and in 4 patients, one of the clamps disengaged; additional operations to achieve bone fusion were required in 9 patients (20%). The Halifax Interlaminar Clamp is safe and effective for posterior stabilization in the lower cervical spine; there is a significant failure rate associated with its use for atlantoaxial arthrodesis.
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The effect of a 2 g/kg intravenous bolus of mannitol on intracranial pressure (ICP) and white matter water content was determined by following the time course of ICP and spatial white matter water content after administration of mannitol in a hemispheric cold lesion model of vasogenic edema in the cat. After mannitol infusion, maximal ICP reduction occurred at approximately 20 minutes and began to return to baseline after 26 minutes. ⋯ White matter water content in the lesioned hemisphere was not changed significantly after mannitol infusion. We conclude that the rapid reduction of ICP after intravenous administration of mannitol is not solely due to the dehydration of white matter.