Neurosurgery
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Randomized Controlled Trial Comparative Study
Waterjet dissection versus ultrasonic aspiration in epilepsy surgery.
Waterjet dissection is currently under close investigation in neurosurgery. Experimentally, precise brain parenchyma dissection with vessel preservation has been demonstrated. Clinically, the safety of the instrument has already been proved. However, precise data demonstrating that waterjet dissection indeed reduces surgical blood loss are still missing. ⋯ The waterjet dissector enables a significant reduction of intraoperative blood loss in the investigated setting. However, further studies are needed to confirm these results with a larger number of patients. Studies also are needed to prove that the reduction of blood loss is of clinical relevance for the outcome of the patients.
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Comparative Study
The cut flow index: an intraoperative predictor of the success of extracranial-intracranial bypass for occlusive cerebrovascular disease.
There has been a resurgence of interest in selective extracranial-intracranial bypass for revascularization of cerebrovascular occlusive disease. We evaluated the usefulness of intraoperative blood flow measurements in predicting graft success after extracranial-intracranial bypass. ⋯ A poor CFI can alert surgeons to potential difficulties with the donor vessel, anastomosis, or recipient vessel during surgery. Furthermore, a CFI closely approximating 1.0 provides physiological confirmation of impaired cerebrovascular reserve in the recipient bed.
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Case Reports
Endoscopic aqueductal stenting via the fourth ventricle under navigating system guidance: technical note.
We report three patients with symptomatic isolated fourth ventricle after ventriculoperitoneal shunt placement for hydrocephalus associated with ventricular hemorrhage. All three patients were treated successfully with our new method of endoscopic aqueductal stenting under navigating system guidance. ⋯ Our method of aqueductal stenting is a reasonable choice for initial treatment of patients with isolated fourth ventricle, and it entails less invasive neurosurgery.
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Progressive kyphotic deformity of the cervical spine may be a late sequela of congenital cervical anomalies, degenerative disc disease, neoplasm, cervical trauma, and surgical procedures. Of these, postsurgical kyphosis is the most common and can occur after ventral and dorsal surgeries of the cervical spine. The purpose of this article is to review the causes and clinical presentation of postsurgical cervical kyphosis and to focus on the operative planning and ventral correction techniques.
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Review Case Reports
Use of "bonnet" bypass with radial artery interposition graft in a patient with recurrent cranial base carcinoma: technical report of two cases and review of the literature.
Two patients with recurrent cranial base carcinomas involving the carotid artery received a "bonnet" bypass using the contralateral superficial temporal artery as the donor vessel because the ipsilateral common and external carotid arteries were unavailable. The radial artery was used as the graft. ⋯ When aggressive resection of cranial base tumors is needed and the ipsilateral carotid artery is unavailable as a donor vessel, a "bonnet" bypass with carotid artery sacrifice may be performed. Compared with vein grafts, microsurgical anastomosis is easier and the patency rate is higher with a radial artery graft.