J Neurosurg Sci
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This article describes a novel hybrid technique for implantation of a combined spinal instrumentation system incorporating lumbosacral facet-joint screw fixation and single- or two-level placement of a lumbar interspinous distractor (X STOP). This system accomplishes two main tasks: 1) immediate rigid fixation of the lumbosacral junction; 2) single- or two-level lumbar decompression with no opening of the spinal canal or intervertebral foramina. This technique may be a reasonable alternative to traditional surgery for patients suffering from multisegmental degenerative disorders of the lumbosacral spine.
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Multicenter Study
A survey of Italian cases of dystonia treated by deep brain stimulation.
The aim of this study was to report on Italian cases of dystonia treated by deep brain stimulation up to the end of 2005. ⋯ Correlation analysis of time to surgery and associated comorbidity suggests that earlier surgery is advisable.
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Acute subdural haematoma (ASDH) is seldom an isolated lesion and it is difficult to understand the mechanisms which determine the poor prognosis associated to this occurrence. Aim of this study was estimating the outcome of patients with ASDH without any companion lesions by analysing the haematoma volume, its thickness and midline shift. ⋯ The presence and size of midline shift was a more important determinant of outcome than ASDH volume or its thickness.
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Surgery for gliomas located inside or in proximity of motor cortex or tracts requires cortical and subcortical mapping to locate motor function; direct electrical stimulation of brain cortex or subcortical pathways allows identification and preservation of motor function. In this study we evaluated the effect which subcortical motor mapping had on postoperative morbidity and extent of resection in a series of patients with gliomas involving motor areas or pathways. ⋯ The motor strip was found in 133 patients (91%) and subcortical motor tracts in 91 patients (62.3%). New immediate postoperative motor deficits were documented in 59.3% of patients in whom a subcortical motor tract was identified intra-operatively and in 10.9% of those in whom subcortical tracts were not observed; permanent deficits were observed in 6.5% and 3.5%, respectively. A total resection was achieved in 94.4% of patients with high-grade gliomas and in 46.1% of those with low-grade gliomas.
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Giant intracranial aneurysms may not be amenable to direct surgical clipping or endovascular coiling because of three critical factors: 1) lack of clear aneurysmal neck; 2) giant size; 3) involvement with critical perforating or branch vessels. Techniques of flow redirection, however, may offer an alternative treatment strategy for these difficult lesions. In this paper, we report on the use of this alternative strategy in the successful treatment of a left giant fusiform carotid terminus-M1 aneurysm in a 16 year-old boy suffering from Ehler-Danlos disease. ⋯ A CT scan on postoperative day 1 revealed that the aneurysm had undergone a spontaneous thrombosis which was completely obliterated at the time of a 6-month follow-up angiogram. At that time, the ECA-ICA bypass was found to be patent. In conclusion the alternative of flow alteration strategies can be successfully used in the treatment of aneurysms that cannot be safely trapped or occluded by traditional neurosurgical methods.