Minim Invas Neurosur
-
Minim Invas Neurosur · Dec 2008
Case ReportsTentorial incision in a lateral-medial direction with minimal retraction of the temporal lobe in the subtemporal transtentorial approach to the middle tentorial incisural space.
The subtemporal transtentorial approach provides excellent exposure of the middle incisural space. A modification of the subtemporal transtentorial approach with use of a partial mastoidectomy is presented to avoid damage to the temporal lobe as a result of retraction as well as damage to venous structures. ⋯ Although additional partial mastoidectomy is time-consuming, it reduces the risk of damage to the temporal lobe as a result of retraction as well as damage to venous structures.
-
Minim Invas Neurosur · Dec 2008
Frameless stereotactic radiosurgery with a bite-plate: our experience with brain metastases.
Non-invasive frameless stereotactic radiosurgical systems have recently been developed. We report our experience of frameless stereotactic radiosurgery (SRS) with a bite-plate for brain metastases. Between February 2002 and December 2005, 147 patients with brain metastases were treated with C-arm linear accelerator-based SRS and 122 patients were followed up by our institute. ⋯ Nine patients who had brain metastases in or close to the brain stem were treated with fractionated stereotactic radiotherapy. The frameless stereotactic radiosurgical system with a bite-plate is safe and effective for the treatment of brain metastasis. Elderly male patients sometimes are edentulous and require placement of a head ring for radiosurgery.
-
Minim Invas Neurosur · Dec 2008
Accuracy and clinical use of a novel aiming device for frameless stereotactic brain biopsy.
Aiming devices enable the use of neuronavigation systems for rigid instrument guidance mimicking the possibilities of a frame-based system without having a stereotactic frame affixed to the skull. The aim of the presented work was to investigate the phantom targeting accuracy of the Vertek aiming device (Medtronic Inc., Louisville, USA) and whether it can be safely and accurately applied in a concept of minimally invasive brain biopsy in which multi-modal image fusion, image-to-patient registration and head immobilization were based on a non-invasive vacuum mouthpiece. A plastic model of a head with 20 target beads broadly distributed around the head volume was used for determination of CT-based targeting accuracy. ⋯ The experimental results showed a similar accuracy to frame-based stereotaxy. The device facilitates trajectory alignment via two pivot joints and the actual depth and location of the biopsy needle can be monitored. Within the limitations of a preliminary study, brain biopsy may be accurately and safely performed for lesions > or = 12 mm.
-
Minim Invas Neurosur · Dec 2008
Case ReportsEndoscopic endonasal management of petroclival cerebrospinal fluid leaks: anatomical study and preliminary clinical experience.
Endonasal management of most anterior cranial fossa cerebrospinal fluid leaks is a well established procedure, and even some middle cranial fossa cerebrospinal fluid leaks can be managed safely endonasally. Endonasal endoscopic management of leakages of the posterior cranial fossa represents an unique challenge. ⋯ Endonasal endoscopic management of well-selected petroclival cerebrospinal fluid leaks is feasible.
-
Minim Invas Neurosur · Dec 2008
Case ReportsCombined treatment of ruptured aneurysm accompanied by intraventricular hemorrhage; neuroendoscopy and coiling: case report.
Subarachnoid hemorrhages with intraventricular hemorrhage (IVH) have been treated with aneurysmal clipping and ventricular drainage. We present a combined treatment with coiling and endoscopy: coiling of the ruptured distal anterior cerebral artery aneurysm and neuroendoscopic removal of IVH.