Neurosurgery
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Comparative Study
Comparison of two techniques to postoperatively localize the electrode contacts used for subthalamic nucleus stimulation.
Cerebral ventriculography (Vg) and magnetic resonance imaging (MRI) scanning are routine procedures to determine the implanted electrode placement into the subthalamic nucleus (STN) and are used in several centers that provide deep brain stimulation for Parkinson's disease patients. However, because of image distortion, MRI scan accuracy in determining electrode placement is still matter of debate. The objectives of this study were to verify the expected localization of the electrode contacts within the STN and to compare the stereotactic coordinates of these contacts determined intraoperatively by Vg with those calculated postoperatively by MRI scans. To our knowledge, this is the first study attempting to compare the "gold standard" of stereotactic accuracy (Vg) with the anatomic resolution provided by MRI scans. ⋯ If we assume that Vg is an imaging gold standard, our results suggest that postoperative MRI scanning may induce a slight image translation compared with Vg. However, MRI scans allowed localization of most of the contacts within the STN.
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The authors present a new method of minimally invasive surgical management of lumbar burst fractures through the posterior approach. The method includes minimally invasive corpectomy and interbody fusion, both of which are performed through a keyhole approach, and percutaneous pedicle screw fixation of the fracture. The technique of the posterior keyhole corpectomy presented in this report is a novel and original concept of the first author (AM). The percutaneous pedicle screw stabilization is performed with the use of a percutaneous instrumentation system (Sextant; Medtronic, Inc., Minneapolis, MN). The Sextant system has been dedicated and used in nontrauma degenerative cases; the novel aspect of this system is its application in spine fractures. Indications for the method include Denis classification subtype B or Magerl subtype A.3.1 burst fractures. Both subtypes represent fractures with failure and retropulsion of the upper part of the vertebral body. ⋯ The advantages of this method include sparing the posterior elements (lamina, spinous process, supraspinous and interspinous ligaments, and paravertebral muscles), safety of the decompression provided by the use of a surgical microscope, and perfect illumination of the operating field. The drawbacks of the method include limitation to certain types of burst fractures, the method is surgically demanding, and the method requires development of a special retractor system to eliminate the cumbersome alternate insertion and the reinsertions of the typical microdiscectomy retractor set.
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A graded approach to cerebrospinal fluid (CSF) leak repair after transsphenoidal surgery is presented. ⋯ A graded repair approach to CSF leaks in transsphenoidal surgery avoids tissue grafts and CSF diversion in more than 60% of patients. Protocol modifications adopted in the last 340 cases have reduced the failure rate to 1% overall and 7% for Grade 3 leaks. Provocative tilt testing before patient discharge is helpful in the timely diagnosis of postoperative CSF leaks.
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For this study, spheno-orbital meningiomas (SOMs) are defined as intraosseus meningiomas at the base of the anterior and middle cranial fossa, involving the sphenoid wing and orbit associated with a carpet-like, soft tissue component. We describe a surgical series of 63 SOMs, including surgical technique, complications, and recurrences. ⋯ Complete surgical resection of SOMs is frequently impossible because the involvement of delicate structures of the orbital cone is common. Although some persisting neurological deficits are possible, proptosis and other visual deficits are often relieved. Two-thirds of tumor rests remained stable during the follow-up period. Consequently, the surgical aim should be the relief of leading symptoms rather than radical resection.
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Fourth ventricular neurocysticercosis (FVNCC) usually presents with obstructive hydrocephalus. Available treatment options are medical, external cerebrospinal fluid diversion, microsurgical, or endoscopic removal alone or in combination. We present our experience of transaqueductal removal of FVNCC by angiographic catheter with endoscopic third ventriculostomy with a rigid endoscope. ⋯ Transaqueductal removal of an intra-fourth ventricular cyst along with endoscopic third ventriculostomy with a rigid endoscope and catheter is an effective treatment and obviates the need for posterior cranial fossa exploration.