Neurosurgical review
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Neurosurgical review · Jan 2016
Review Meta AnalysisSpinal cord stimulation for Parkinson's disease: a systematic review.
Axial symptoms are a late-developing phenomenon in the course of Parkinson's disease (PD) and represent a therapeutic challenge given their poor response to levodopa therapy and deep brain stimulation. Spinal cord stimulation (SCS) may be a new therapeutic approach for the alleviation of levodopa-resistant motor symptoms of PD. Our purpose was to systematically review the effectiveness of SCS for the treatment of motor symptoms of PD and to evaluate the technical and pathophysiological mechanisms that may influence the outcome efficacy of SCS. ⋯ The overall motor score of the Unified Parkinson's Disease Rating Scale in the on/off-stimulation condition remained unchanged in 6 patients and improved in 18 patients after SCS. SCS appears to yield positive results for PD symptoms, especially for impairments in gait function and postural stability. However, evidence is limited and long-term prospective studies will be required to identify the optimal candidates for SCS and the best parameters of stimulation and to fully characterize the effects of stimulation on motor and nonmotor symptoms of PD.
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Neurosurgical review · Jan 2016
Surgical management of spontaneous cerebrospinal fluid leakage through temporal bone defects--case series and review of the literature.
Increasing numbers of cases of idiopathic cerebrospinal fluid (CSF) leakage through temporal bone defects (TBD) have been recently reported, mainly in otolaryngologic journals. Those cases are referred to as spontaneous temporal bone encephaloceles (TBE). Three surgical approaches have been advocated for this condition: the transmastoid approach (TMA), the middle cranial fossa approach (MCFA), or a combination of both. ⋯ It revealed a trend favoring the use of the MCFA approach over the TMA approach, with an acceptable risk of less than 5% for craniotomy-related complications. We concluded that MCFA is an effective and safe technique for the repair of CSF leakage through TBD. A high percentage of complete resolution with a low complication rate can be achieved with this surgical technique.
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Neurosurgical review · Jan 2016
Factors influencing the outcome (GOS) in reconstructive cranioplasty.
After performing a decompressive craniectomy, a cranioplastic surgery is usually warranted. The complications of this reconstructive procedure may differ from the initial operation. The authors of this study report on their experience to define patient-specific and procedural risk factors for possible complications following cranioplasty influencing the outcome (Glasgow Outcome Scale (GOS)), mobility, shunt dependency, and seizures. ⋯ Evaluation of treatment modality in aneurysmal SAH clip vs. coil showed no significant relation to postoperative complications either. Complications after cranioplastic surgery are a common problem, as prognostic factors could identify a shunt-depending hydrocephalus and epilepsia to develop a major deficit after cranioplastic surgery (GOS 2 or 3). We detected a significant extra risk of people between the age of 51 and 70 years to end up in GOS level 2 or 3.
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Neurosurgical review · Oct 2015
ReviewThe current status of 5-ALA fluorescence-guided resection of intracranial meningiomas-a critical review.
Meningiomas are the second most common primary tumors affecting the central nervous system. Surgical treatment can be curative in case of complete resection. 5-aminolevulinic acid (5-ALA) has been established as an intraoperative tool in malignant glioma surgery. A number of studies have tried to outline the merits of 5-ALA for the resection of intracranial meningiomas. ⋯ However, only one study was able to consistently correlate resected tissue with histopathological results and nonspecific fluorescence of healthy brain tissue remains a confounder. The use of 5-ALA as a tool to guide resection of intracranial meningiomas remains experimental, especially in cases with tumor recurrence. The principle of intraoperative fluorescence as a real-time method to achieve complete resection is appealing, but the usefulness of 5-ALA is questionable. 5-ALA in intracranial meningioma surgery should only be used in a protocolled prospective and long-term study.
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In patients with traumatic brain injury (TBI) and ischemic hemispheric stroke (IHS), supratentorial decompressive craniectomy (DC) is performed when intracranial pressure (ICP) is unresponsive to medical treatment. There are numerous publications about the indications of supratentorial DC, the selection of patients eligible for surgery, the complications of the procedure, and the neurological outcome of operated patients. ⋯ Based on the literature reviewed, this article gathers features that had been developed with the intent to improve the decompressive effect of this surgery and evaluates if there is a strong recommendation for clinical practice. The existing literature does not supply class I evidence of how an ideal DC should be designed to reduce peri- and postoperative complications and to provide the best functional outcome.