Neurosurgical review
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Neurosurgical review · Jan 2013
Long-term follow-up of ruptured intracranial aneurysms treated by microsurgical wrapping with autologous muscle.
The purpose of this study is to describe our series of nine unclippable and uncoilable ruptured aneurysms in eight patients treated by microsurgical wrapping with autologous muscle. Records were retrospectively reviewed for rebleeding rate, morbidity and mortality, changes in size or the aneurysm's configurations, and inflammatory reaction. We conducted a Medline search in the post-microsurgical era, excluding patients in whom wrapping was part of the aneurysm treatment in combination with clipping or coiling. ⋯ Follow-up MR demonstrated persistence of the aneurysm's sac, without changes in size and configuration. Patients did not describe or exhibit symptoms attributable to complications inherent to the use of muscle. Microsurgical muscle-wrapping of ruptured intracranial aneurysm is safe, is associated with a low rate of acute and delayed postoperative complications and rebleeding, and could be a valid alternative for unclippable and non-amenable to endovascular procedure ruptured aneurysms.
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Neurosurgical review · Jan 2013
The endoscopic endonasal approach for the management of craniopharyngiomas involving the third ventricle.
The third ventricle has historically represented one of the most challenging areas to access surgically, so that lesions directly harboring into the ventricular chamber or secondarily extending into it from adjacent areas have been approached by means of different transcranial routes. The aim of this work is to report our experience with the endoscopic endonasal approach in the management of a series of patients affected by craniopharyngiomas, extending into or arising from the third ventricle, evaluating pros and cons of this technique, also in regards of the anatomy and the pathology dealt with. During the period between January 2001 and February 2011, 12 patients, 9 male and 3 female (mean age 50.4 years; range 12-68) underwent an endoscopic endonasal approach for the treatment of a craniopharyngioma involving or arising from the third ventricle. ⋯ One patient died after the occurrence of a brainstem hemorrhage. The endoscopic endonasal route provides a good exposure, especially of the sub- and retro-chiasmatic areas, as well as of the stalk-infundibulum axis, which represents, when directly involved by a lesion, a gate to access the third ventricle chamber. Despite this study reporting only a preliminary experience, it seems that in properly selected cases--namely tumors growing mostly along the pituitary stem-infundibulum-third ventricle axis--this approach could be advocated as a valid route among the wide kaleidoscope of surgical approaches to the third ventricle.
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Neurosurgical review · Jan 2013
Case ReportsBasilar trunk perforator artery aneurysms. Case report and literature review.
Perforator artery aneurysms of the basilar trunk are rarely described in the literature. In addition to presenting our own case, we performed a PubMed search to comprehensively illustrate demographics, hemorrhage patterns, and treatment outcomes for these lesions. We found 12 patients with basilar perforator artery aneurysms. ⋯ Basilar perforator artery aneurysms may be sources of hemorrhage in diffuse or perimesencephalic/prepontine SAH. While endovascular coiling is an excellent option if parent vessel anatomy allows for catheterization, many are unamenable to endovascular treatment. Surgical obliteration via proximal occlusion or trapping is a safe and effective means of treating these aneurysms.
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Neurosurgical review · Jan 2013
Comparative StudyChronic subdural haematomas: a comparative study of an enlarged single burr hole versus double burr hole drainage.
Various surgical treatments have been proposed for the treatment of chronic subdural haematoma (CSDH). Herewith, we set out to compare the efficacy of an enlarged single burr hole versus double burr hole drainage for the treatment of CSDH. We studied patients with symptomatic CSDH proven by CT scan that were treated in our institute between January 2002 and January 2009. ⋯ The mean hospitalization time was 6.2 days, and there was no significant difference between the two groups. No significant difference was found between patients' outcome, as assessed by Glasgow outcome scale score, and treatment method. Enlarged single burr hole and double burr hole drainage had the same efficacy in the treatment of CSDH.
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Neurosurgical review · Jan 2013
Comparative StudyComparison of navigated transcranial magnetic stimulation and functional magnetic resonance imaging for preoperative mapping in rolandic tumor surgery.
Navigated transcranial magnetic stimulation (nTMS) is a novel tool for preoperative functional mapping. It detects eloquent cortical areas directly, comparable to intraoperative direct cortical stimulation (DCS). The aim of this study was to evaluate the advantage of nTMS in comparison with functional magnetic resonance imaging (fMRI) in the clinical setting. ⋯ Using nTMS, a preoperative localization of the central sulcus was possible in all patients. Verification of nTMS motor cortex localization with DCS was achieved in all cases. The fMRI localization of the hand area proved to be postcentral in one case. nTMS has fewer restrictions for preoperative functional mapping than fMRI and requires only a limited level of compliance. nTMS scores higher on the accuracy scale than fMRI. nTMS represents a highly valuable supplement for the preoperative functional planning in the clinical routine.