Neurosurgery
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Comparative Study
Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas.
We analyzed the outcome of patients with symptomatic vertebral hemangiomas treated at University of California, San Francisco, over a 20 year period. Treatment included transarterial embolization, embolization followed by surgical decompression or vertebral reconstruction with arthrodesis, and percutaneous vertebroplasty alone. ⋯ Transarterial embolization followed by laminectomy is a safe and effective procedure for the treatment of cord compression by vertebral hemangioma causing stenosis without instability or deformity. Vertebrectomy preceded by embolization and followed by reconstruction can be used to treat cord compression from extraosseous tumor extension. Transarterial embolization without decompression is an effective treatment for painful intraosseous hemangiomas. Vertebroplasty is useful for improving pain symptoms, especially when vertebral body compression fracture has occurred in patients without neurological deficit, but is less effective in providing long-term pain relief.
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Comparative Study Clinical Trial
Use of a tubular retractor system as a minimally invasive technique for epidural plate electrode placement under local anesthesia for spinal cord stimulation: technical note.
To improve the technique of placement of large plate electrodes for spinal cord stimulation with a minimally invasive approach using the METRx tubular retractor system (Medtronic Sofamor Danek, Minneapolis, MN). This dilating system splits the paravertebral musculature, avoiding the need to strip these muscles from the spine. The technique described makes it possible to perform the procedure (currently, it is most frequently performed using general anesthesia) with local anesthesia and sedation, allowing test stimulation, and with little intraoperative or postoperative discomfort for the patient. ⋯ Using a tubular retractor system, implantation of plate electrodes for spinal cord stimulation can be performed under local anesthesia with acceptable discomfort for the patient, making the approach of the spinal canal minimally invasive. This method allows test stimulation to assess the correct electrode position and results in less local postoperative discomfort because of the small-muscle splitting approach.
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Comparative Study Clinical Trial
Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging.
The two most recent significant advances in pituitary surgery have been the endonasal endoscopic approach and intraoperative magnetic resonance imaging (IMRI). Each provides improved visualization of intra- and parasellar anatomy with the goal of attaining a complete resection. The combination of the two techniques has not been previously reported in the literature. ⋯ Combining intraoperative endoscopy and IMRI is feasible and distortion of the cathode ray tube screen can be overcome with the use of either a plasma or liquid crystal display screen. Each technology provides complementary information, which can assist the surgeon in safely maximizing the extent of resection. In this small series using a low-field magnet, rates of residual tumor following endoscopic transsphenoidal surgery were less than have been reported following microscope-based transsphenoidal surgery.
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Comparative Study Clinical Trial
FLAIR-/T1-/T2-co-registration for image-guided diagnostic and resective epilepsy surgery.
For technical reasons, T2-weighted and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) sequences do not allow morphological orientation with high anatomic resolution, but they may show small epileptogenic lesions. Considering the peculiarities of diagnostic and resective epilepsy surgery the present study focused on the co-registration of various magnetic resonance sequences for guided epilepsy surgery. ⋯ Image guidance on the basis of image fusion/co-registration of T1- and FLAIR-/T2-images allows for intraoperative identification of otherwise poorly visible lesions on standard MRI sequences in good spatial resolution. Recall of this information during surgery from the navigation system's screen assists in achieving the goal of precise electrode placement, or complete resection of the lesion as well as of the perilesional epileptogenic tissue and improves the surgeon's intraoperative orientation.
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Comparative Study Clinical Trial
Pretargeting for the implantation of stimulation electrodes into the subthalamic nucleus: a comparative study of magnetic resonance imaging and ventriculography.
The optimal imaging modality for preoperative targeting of the subthalamic nucleus (STN) for high-frequency stimulation is controversially discussed. Commonly used methods were stereotactic magnetic resonance imaging (MRI), stereotactic ventriculography, and fusion between MRI and stereotactic computer tomography. All of these techniques not only have their own advantages but also specific limitations and drawbacks. The purpose of this study was to evaluate the accuracy of the preoperative MRI targeting as compared with ventriculography in terms of both the STN target as well as the internal landmarks. ⋯ Our findings show that the indirect targeting of the STN using coordinates based on radiological landmarks is more accurate than the direct targeting using anatomic visualization of the target structure. Regardless of the imaging procedure, electrophysiological mapping is required for optimal electrode placement, although in 20% of cases, the target determined by MRI falls out of the radius explored by electrophysiology.