Minim Invas Neurosur
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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.
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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.
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Minim Invas Neurosur · Dec 2008
Case ReportsTumor resection utilizing a minimally invasive spinal retractor with a novel cranial adaptor.
This article describes a method of performing an intracerebral tumor resection utilizing a novel dilator attachment with a system designed for minimally invasive spinal surgery. ⋯ Tumor resection can safely be accomplished using a minimally invasive spine retractor system with a novel dilator adapted for the system. This reduces the size of the cortisectomy and therefore reduces the risk of post-operative neurological damage while still allowing ample room for adequate tumor resection.
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Minim Invas Neurosur · Oct 2008
Case ReportsMultiple aneurysms of the distal posterior inferior cerebellar artery: two case reports.
The distal segment of the PICA (posterior inferior cerebellar artery) is a very rare localization for the occurrence of intracranial aneurysms. They are almost always presented with SAH (subarachnoid hemorrhage). Hydrocephalus often develops following intraventricular hemorrhage (IVH). The distal PICA segment is a quite difficult localization for neurosurgical procedures. The authors could not find any case report presenting multiple aneurysms on a distal segment of PICA in the literature. CASE 1: A 62-year-old male patient was admitted to the emergency room with complaints of sudden headache, vomiting and blackout of consciousness. Early CT scans demonstrated SAH and intraventricular hemorrhage (IVH). In his medical history, SAH had been determined in our clinic 3 month previously. He had carried out conservative treatment ever since the distal located PICA aneurysm had been determined. There was no determined symptom except for moderate neck stiffness in his physical examination. In his neurological examination, he was stuporous and he localized the pain in his left arm. A ventriculo-atrial shunt operation was performed after the external ventricular drainage which was applied at the acute period of hydrocephalus in his previous SAH. Both of the left distal PICA aneurysms were clipped via a left lateral suboccipital craniotomy. The patient was discharged from the hospital without neurological deficit in the seventh day postoperatively. His control examination was normal and there was not any fixed pathological filling in the control cerebral digital subtraction angiography (DSA). CASE 2: A 49-year-old female patient was admitted to the emergency service with the complaint of headache, dizziness and vomiting. She was neurologically intact except for neck stiffness. A cranial CT demonstrated triventricular hydrocephalus and a hemispheric cerebellar hematoma, which was about 1 x 1.5 cm in diameter. The cerebellar DSA was normal. The patient was discharged with no neurological impairment. In the examination of the control cerebral DSA, two aneurysmatic fillings were determined in the distal segments of right posterior inferior cerebellar artery (PICA). Both of the aneurysms were clipped through a microsurgical approach. No neurological deficit was determined in the postoperative early and late stages. In the control cerebral DSA, no aneurysmatic filling was seen. ⋯ Distal PICA aneurysms constitute only 0.28-1.4% of all intracranial aneurysms. Most of the patients present with SAH and along with this; intraventricular hemorrhage is seen and later on, hydrocephalus develops. As for treatment, surgery and endovascular interference methods can be applied.
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Minim Invas Neurosur · Oct 2008
Postoperative management of incidental durotomy in minimally invasive lumbar spinal surgery.
Unintended durotomy is a relatively common complication in spine surgery, with a reported incidence up to 14%. Traditional management has been mandatory bed rest for at least 48 h following repair, with or without placement of a drain. With the muscle-splitting approach and decreased potential (dead) space created during minimally invasive spinal surgery (MISS), there is less potential likelihood of symptoms such as spinal headaches or cerebrospinal fluid fistulas. ⋯ One patient was mobilized early on the second postoperative day, 2 patients were mobilized the morning after surgery, and 2 patients were mobilized immediately upon recovery from anesthesia. None of the patients developed symptoms related to durotomy. Although this represents a small series, early postoperative mobilization appears to be a reasonable option and results in shorter hospitalization.