Minim Invas Neurosur
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Minim Invas Neurosur · Aug 2008
Spinous process splitting laminectomy for lumbar canal stenosis: a critical appraisal.
Spinous process splitting laminectomy (SPSL) is a surgical technique for lumbar canal stenosis, which aims to preserve the paraspinal muscles. Twenty-five patients with lumbar canal stenosis who consecutively underwent SPSL from June 2005 to December 2005 were evaluated. Clinical outcomes were assessed using the visual analogue scale (VAS) scores and Oswestry disability index (ODI). ⋯ However, a significant improvement (> 50% of their initial VAS/ODI score) of back pain, leg pain, and functional status was observed in only 65.2, 65.2, and 52.2%, respectively. Complications occurred in 4 patients (16%). Although SPSL for lumbar canal stenosis yielded relatively good clinical outcomes, the percentage of patients showing significant improvements in back pain, leg pain, and functional status were less than expected at one year after surgery.
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Minim Invas Neurosur · Aug 2008
Endoscopic endonasal transsphenoidal surgery using a skull reference array and laser surface scanning.
Lesions of the skull base are increasingly being resected via the endoscopic, endonasal, transphenoidal approach. We have successfully treated 33 consecutive patients with pituitary lesions using this technique in combination with BrainLAB skull reference array and laser surface scanning for surgical navigation. ⋯ This is particularly important as extension and flexion of the head provide greater exposure to the clivus and anterior skull base respectively. Also, this technique obviates the need for additional preoperative MRI, thereby reducing cost and delays.
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Minim Invas Neurosur · Aug 2008
Assessment of incomplete clipping of aneurysms intraoperatively by a near-infrared indocyanine green-video angiography (Niicg-Va) integrated microscope.
The objective of this article was to assess the clinical use and the completeness of clipping with total occlusion of the aneurysmal lumen, real-time assessment of vascular patency in the parent, branching and perforating vessels, intraoperative assessment of blood flow, image quality, spatial resolution and clinical value in difficult aneurysms using near infrared indocyanine green video angiography integrated on to an operative Pentero neurosurgical microscope (Carl Zeiss, Oberkochen Germany). ⋯ The operative microscope-integrated ICG video angiography as a new intraoperative method for detecting vascular flow, was found to be quick, reliable, cost-effective and possibly a substitute or adjunct for Doppler ultrasonography or intraoperative DSA, which is presently the gold standard. The simplicity of the method, the speed with which the investigation can be performed, the quality of the images, and the outcome of surgical procedures have all reduced the need for angiography. This technique may be useful during routine aneurysm surgery as an independent form of angiography and/or as an adjunct to intraoperative or postoperative DSA.