British journal of neurosurgery
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Comparative Study
The advantages of frameless stereotactic biopsy over frame-based biopsy.
A comparison study is presented, which examines the outcome, complications and cost of stereotactic brain biopsy performed with a frameless versus a frame-based method. The technique of frameless stereotactic biopsy has been shown previously, in both laboratory and in vivo studies, to achieve a level of accuracy at least equal to frame-based biopsy. The investigators have validated the technique in a large clinical series. ⋯ This resulted in lower ITU bed occupancy (p = 0.02), shorter mean hospital stay (p = 0.0013) and significant cost savings (p = 0.0022) for the frameless stereotactic biopsy group, despite the greater use of more expensive MRI in these cases. This comparison study demonstrates that the superior imaging, target visualization and flexibility of the technique of frameless stereotactic biopsy translates into tangible advantages for safety, time and cost when compared with the current gold-standard of frame-based biopsy. The principles are discussed and the authors propose a definition for the term 'frameless stereotaxy'.
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Treatments of atlanto-axial rotatory subluxation in children are generally conservative. Previous reports have proposed that surgical treatment be reserved for fixed rotatory subluxation of more than 3 months duration, irreducible deformity or cases of recurrence. Six skeletally immature patients with Fielding type III atlanto-axial rotatory subluxation were treated conservatively with or without subsequent atlanto-axial arthrodesis. ⋯ Neither mortality nor major morbidity was noted in any cases in this study. In our experience, type III fixed rotatory subluxation of 6 weeks duration will potentially recur. We recommend early surgery for type III fixed rotatory subluxation of more than than 3 months' duration, with atlanto-axial arthrodesis being a safe and effective procedure in children.
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Over recent years frameless stereotactic systems have begun replacing framed systems for many neurosurgical procedures. However, little has been published regarding the use of these systems to guide intracranial electrode implantation for epilepsy surgery patients. Here we report our experience utilising such a system to insert depth electrodes and subdural grid electrodes. ⋯ The only long-term complication was a case of osteomyelitis which required removal of the bone flap. 73% of patients had an excellent seizure outcome. Frameless stereotactic systems can be safely used to intracranial electrodes, avoid the disadvantages of the framed system and have the added advantage of the surgeon being able to visualise the trajectory and to adjust this to avoid vital structures. As well they eliminate surgical obstruction to the insertion of subdural grids at the same operation, which may be caused by a framed system.
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Neurosurgical care is limited in many parts of the world to one or two hospitals serving a large geographic area. The quality of neurosurgical response to emergencies depends on the reliability and completeness of the information received from referral hospitals. The aim of this study is to show how application of guidelines for head injury management in an entire area can be usefully combined with transmission of images from the peripheral to the central hospital. ⋯ Unnecessary transfers can be avoided and the neurosurgeons can evaluate the images of a number of patients who have always been treated outside our Units. This results in more work for the neurosurgeons on duty, but also in a better quality service for the whole area. The lack of follow-up for patients not admitted to Neurosurgery is the limitation on a quality assessment of the system.
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We describe an apparently unique case of a patient with a trigeminal neuralgia caused by compression of the trigeminal nerve during its course by the draining vein of a developmental venous anomaly in the cerebellopontine angle. Typical symptoms of trigeminal neuralgia disappeared completely after microvascular decompression of the nerve. Neuroradiological findings, as well as particularities of this case are described and therapeutic options are discussed.