Neurosurgery
-
The treatment of hydrocephalus by cerebrospinal fluid shunting is plagued by ventricular catheter obstruction. Shunts can become obstructed by cells originating from tissue normal to the brain or by pathological cells in the cerebrospinal fluid for a variety of reasons. In this review, the authors examine ventricular catheter obstruction and identify some of the modifications to the ventricular catheter that may alter the mechanical and chemical cues involved in obstruction, including alterations to the surgical strategy, modifications to the chemical surface of the catheter, and changes to the catheter architecture. It is likely a combination of catheter modifications that will improve the treatment of hydrocephalus by prolonging the life of ventricular catheters to improve patient outcome.
-
Review Case Reports Clinical Trial
The use of transcutaneous thermal convection analysis to assess shunt function in the pediatric population.
The diagnosis of shunt malfunction is largely made by subjective clinical history and assessment in association with neurodiagnostic imaging. ⋯ Our current research suggests that cerebrospinal fluid flow as detected by thermoconvection analysis is not a reliable indicator of shunt function in the pediatric population.
-
Review Case Reports
The use of intraoperative electrophysiology for the placement of spinal cord stimulator paddle leads under general anesthesia.
Placement of spinal cord stimulating paddle leads has traditionally been performed under local anesthesia with intravenous sedation to allow intraoperative confirmation of appropriate placement. It may be difficult to maintain appropriate sedation in certain patients because of medical comorbidities. Furthermore, patients undergoing lead revision frequently have extensive epidural scarring, requiring multilevel laminectomies to place the electrode appropriately. ⋯ The use of intraoperative electrophysiology for the placement of spinal cord stimulation paddle leads under general anesthesia is a safe and efficacious alternative to awake surgery.
-
Review Case Reports
Bending the curve: preoperative determination of bypass graft length and trajectory with curved planar reformatted computed tomography angiography: technical note.
Cerebral revascularization continues to be an important technique for the treatment of cerebrovascular and vaso-occlusive diseases, and determination of appropriate graft sources and recipients is paramount to the success of the procedure. A tension-free anastomosis requires that harvested grafts be of an appropriate length to avoid complications. Volume-rendered contrast-enhanced computed tomography data sets may be useful in determining the desired length and path of the bypass graft and in the evaluation of appropriate recipient vessels. Curved planar reformation techniques may allow these properties to be determined in a novel, inexpensive, and efficient manner. ⋯ Curved planar reformation technique can be used for preoperative planning of cerebral bypass procedures and is a novel, inexpensive, and efficient means of determining the desired length and path of the bypass graft and in the evaluation of appropriate recipient vessels.
-
Review Case Reports
Direct lateral approach to pathology at the craniocervical junction: a technical note.
Approaches to the foramen magnum and upper cervical spine traditionally include the posterior midline, far lateral, and endoscopic endonasal approaches. The far lateral approach is a well-established technique for the removal of pathology ventrolateral to the brainstem and the craniocervical junction, but it may be too extensive for lesions limited to areas far from the midline. ⋯ This approach can be considered for patients in whom a ventral decompression is necessary but an endoscopic endonasal approach is undesirable or when a ventral, lateral, and ventrolateral resection of tumor, pannus, or infection is required.