Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Posterior decompression with instrumented fusion (PDF) surgery has been previously reported as a relatively safe surgical procedure for any type of thoracic ossification of the longitudinal ligament (OPLL). However, mid- to long-term outcomes are still unclear. The aim of the present study was to elucidate the mid- to long-term clinical outcome of PDF surgery for thoracic OPLL patients. ⋯ Decompression surgery for deterioration of symptoms of pre-existing cervical OPLL was performed in three patients. One patient had undergone lumbar and cervical PDF surgery for de novo ossification foci of the lumbar and cervical spine. PDF surgery for thoracic OPLL is thus considered a relatively safe and stable surgical procedure considering the mid- to long-term outcomes.
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Patient outcomes following grade V subarachnoid haemorrhage (SAH) have been dismal, although they may have improved following recent technological advances in endovascular treatment (EVT). A single-centre, retrospective study was conducted to evaluate whether outcomes have improved from 2000 to 2014 for patients with World Federation of Neurosurgical Societies (WFNS) grade V SAH. Coiling has been the preferred first-line treatment for grade V SAH patients in our institution since 2000. ⋯ Age was the only variable associated with favourable outcomes. The results of this study indicate that EVT is an appropriate therapeutic option for grade V SAH patients. However, multi-centre, prospective trials are required to provide evidence-based verification of the efficacy of EVT.
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The pterional approach was described in the 1970s and has become the most utilized cranial approach with many variations described, including the minipterional technique. Although described recently as an alternative to the pterional approach for anterior circulation aneurysms, to our knowledge a large series of cases using the minipterional approach in both ruptured and unruptured aneurysms has not been described. We present our clinical experience with the minipterional craniotomy in more than 100 ruptured and unruptured anterior circulation aneurysms. ⋯ Outcome results were classified as excellent in 67 (77.9%), and good in seven (8.1%), while 16 (13.9%) patients died. The minipterional technique provides adequate surgical exposure and excellent outcomes for both ruptured and unruptured anterior circulation aneurysm clipping. It constitutes a safe and effective alternative to the pterional approach, with equivalent or potentially better aesthetic and functional outcomes.
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Ventriculoperitoneal (VP) shunt insertion is a common neurosurgical procedure, essentially unchanged in recent years, with high revision rates. We aimed to identify potentially modifiable associations with shunt failure. One hundred and forty patients who underwent insertion of a VP shunt from 2005-2009 were followed for 5-9years. ⋯ In conclusion, poor catheter placement (revision rate 77%) was found to be the strongest predictor of shunt failure, with no difference in revisions between excellent (43%) and moderate (43%) catheter placement. Avoiding poor placement in those with mild or moderate ventriculomegaly may best reduce VP shunt failures. There may also be an influence of valve choice on VP shunt survival.
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Intraventricular hemorrhages (IVH) can occur as a consequence of spontaneous intracerebral hemorrhage, aneurysm rupture, arteriovenous malformation hemorrhage, trauma, or coagulopathy. IVH is a known risk factor for poor clinical outcome with up to 80% mortality. The current standard treatment strategy for IVH consists of the placement of an external ventricular drain. ⋯ Most of the IVH reduction occurred in the frontal horn and atrium of the lateral ventricle, as well the third ventricle. One (1/8) procedure-related complication occurred consisted of a tract hemorrhage. The Apollo system can be used for minimally invasive IVH evacuation to achieve significant blood clot volume reduction with minimal procedure-related complication.