Neurosurgery
-
Case Reports
Treatment of a superior sagittal sinus dural arteriovenous fistula with Onyx: technical case report.
The endovascular treatment of a complex superior sagittal sinus dural arteriovenous fistula with ethylene vinyl alcohol copolymer (Onyx) in one session is described. ⋯ Definitive treatment may be attained with Onyx in dural arteriovenous fistulas. The potential of Onyx for use as a permanent embolic agent in dural arteriovenous fistulae needs to be investigated.
-
We determined whether the accuracy of lumbar pedicle screw placement is optimized by performing a laminectomy before screw placement with screw entry point and trajectory being guided by pedicle visualization and palpation (Technique 1). This technique was compared with a technique using anatomic landmarks for pedicle screw placement (Technique 2). The biomechanical stability of the instrumented constructs, in the absence and presence of a laminectomy, was also compared. ⋯ All screw placements were grossly within the confines of the pedicles, regardless of technique, as evidenced by computed tomographic analysis. Furthermore, the anatomic landmark technique and the open laminectomy technique yielded biomechanically equivalent pedicle screw and rod-fixated constructs.
-
To assess the advantages and disadvantages of the retrosigmoid intradural suprameatal approach by studying the microsurgical anatomy. This study was performed primarily to assess the advantages of the retrosigmoid intradural suprameatal approach by measuring the amount of increased exposure it provides for lesions of the cerebellopontine and petroclival region as well as to identify the disadvantages of the approach. ⋯ This approach is suitable for lesions mainly in the posterior fossa with some extension into the middle fossa in the anterolateral direction. The key benefits of this approach are the length of trigeminal nerve exposure and the subsequent mobilization that improves visualization of the structures medial to the internal auditory canal, to the petrous apex, Meckel's cave, and the posterior end of the cavernous sinus.
-
Randomized Controlled Trial
Preserving the ligamentum flavum in lumbar discectomy: a new technique that prevents scar tissue formation in the first 6 months postsurgery.
Postoperative fibrosis is one of the most important causes of failed back surgery syndrome after lumbar disc surgery. Numerous natural and synthetic materials have been investigated as means to prevent or reduce postoperative scarring after these operations. Preservation of the ligamentum flavum for this purpose has not been studied in depth. A prospective, randomized, controlled clinical study was conducted. The aim was to present a new technique for preserving the ligamentum flavum during lumbar discectomy, and to evaluate whether this helps prevent or diminish postoperative fibrosis. ⋯ The groups both showed satisfactory clinical outcomes and the improvements were comparable; however, the group with preserved ligamentum flavum showed significantly less local fibrosis at 6 months postoperatively. The authors speculate that this surgical technique provides a physical protective barrier that can reduce or even eliminate fibrosis-related complications after lumbar disc surgery.
-
Comparative Study
Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale.
We developed a modification of the Fisher computed tomographic rating scale and compared it with the original Fisher scale to determine which scale best predicts symptomatic vasospasm after subarachnoid hemorrhage. ⋯ The modified Fisher scale, which accounts for thick cisternal and ventricular blood, predicts symptomatic vasospasm after subarachnoid hemorrhage more accurately than original Fisher scale.