Minim Invas Neurosur
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Minim Invas Neurosur · Dec 2003
Case ReportsSurgical strategies for treatment of giant or large intracranial aneurysms: our experience with 139 cases.
Giant or large intracranial aneurysms are the vascular neurosurgeon's greatest challenge. At our department, we have treated one hundred and thirty nine patients with giant or large intracranial aneurysms between 1975 and 2001. These included 37 partially thrombosed giant aneurysms. 75 aneurysms were giant (> 2.5 cm) and 64 were large aneurysms (2-2.5 cm). ⋯ While selecting surgical strategy for partially thrombosed giant aneurysm, securing the neck is most important. If the neck is too narrow to reconstruct, aneurysmectomy with anastomosis is one of the surgical strategies. An extracranial intracranial bypass should be considered in cases where clipping or parent artery ligation is expected to be associated with compromise of cerebral circulation.
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Minim Invas Neurosur · Oct 2003
Case ReportsTechnical refinements for validating functional MRI-based neuronavigation data by electrical stimulation during cortical language mapping.
Preoperative functional neuroimaging techniques represent an appealing method to localize language areas in tumor surgery, but their reliability still needs to be confirmed by accurate comparison with more invasive but validated mapping techniques like intraoperative electrical cortical stimulation. Two patients harboring a glioma involving speech areas underwent mapping of language function by preoperative functional magnetic resonance imaging (fMRI), whose results were integrated into the neuronavigation device, and by intraoperative electrical stimulation mapping (ESM). The utilization of neuronavigation allowed us to estimate the degree of spatial correspondence between language areas detected by the two techniques. ⋯ It was possible to achieve a gross total tumor removal while respecting language areas in both cases, with no permanent postoperative phasic aggravation. The concordance of results between pre- and intraoperative mapping techniques in our patients indicates that preoperative fMRI language mapping may prove useful when planning the resection of intracerebral lesions in language areas. However, accurate neurofunctional imaging protocols and image analysis are crucial to obtain a preoperative language mapping that is in agreement with ESM findings.
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Minim Invas Neurosur · Oct 2003
Case ReportsEndoscopic-assisted craniofacial resection of esthesioneuroblastoma: minimizing facial incisions--technical note and report of 3 cases.
The surgical management of esthesioneuroblastoma with anterior skull base involvement has traditionally been craniofacial resection, which combines a bifrontal craniotomy with a transfacial approach. The latter usually involves a disfiguring facial incision, mid-facial degloving, lateral rhinotomy, and/or extensive facial osteotomies, which may be cosmetically displeasing to the patient. The advent of angled endoscopes has provided excellent magnification and illumination for surgeons to remove tumors using minimally invasive techniques. ⋯ All patients underwent complete tumor resection with negative margins. None developed a cerebrospinal fluid (CSF) leak. The endoscopic-assisted craniofacial approach for the surgical management of esthesioneuroblastomas provides excellent exposure, adequate visualization, and the cosmetic benefit of avoiding an external facial incision.
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Minim Invas Neurosur · Aug 2003
Case ReportsUnsuccessful third ventriculostomy for occlusive hydrocephalus.
For non-communicating hydrocephalus, neuroendoscopic third ventriculostomy has become a major choice. But sometimes, the procedure results in failure. ⋯ Recently some reports have noticed the importance of the flow of CSF into the prepontine cistern, mimicking the flow through the aqueduct of Sylvius. We report an unsuccessful trial of third ventriculostomy in a case with huge posterior fossa tumor.
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Minim Invas Neurosur · Aug 2003
Case ReportsNeuroendoscopy: one year of experience--personal results, observations and limits.
After reading reports of successful neuroendoscopic treatment of hydrocephalus, colloid cysts and arachnoid cysts as well as tumor biopsy, we started using endoscopic procedures in our Department, one year ago. One surgeon (E. S.) skilled in the Decq Endoscope, performed a series of sixteen procedures, from January 2001 to March 2002 (in patients aged 28 to 69 years). ⋯ Complication occurred in one case with chronic subdural collection. We further report one case of aqueductal restoration after third ventriculostomy. Our results, with no neurological deficits or deaths, confirmed our opinion that neuroendoscopy is a safe surgical technique in well-selected patients and we believe it is the ideal treatment in obstructive hydrocephalus.