World Neurosurg
-
Thrombosed brain aneurysm is usually treated by cerebrovascular surgery rather than endovascular surgery. The basilar-superior cerebellar artery (BA-SCA) aneurysm can be accessed via the transsylvian, temporopolar, or anterior temporal approaches. However, a disadvantage of these approaches is that the surgical route is obstructed by the internal carotid artery (ICA). Therefore, we propose that after establishing a high-flow bypass, severing the ICA will enable safe clipping of a BA-SCA aneurysm. ⋯ Intentional severing of the ICA after establishing a high-flow bypass will not become the standard technique for treatment of upper basilar artery aneurysms. However, this technique can extend the operative field to allow clipping of an upper basilar artery aneurysm after several skull base techniques.
-
Intraoperative fluorescein detection has been used in the fields of vascular and oncologic neurosurgery since 1948. Modifications of the optics in order to enhance the fluorescence contrast under microscopic view have been developed by many authors. The industries, during the past 10 years, provided commercial high-cost optimized apparatuses. Reviewing the literature, we found that the prototypical techniques were definitely inexpensive but lacked reliability, reproducibility, and standard legal norms. ⋯ Our results show a good distinction of fluorescein-stained structures, with overall acceptable operating light conditions.
-
Controlled Clinical Trial
Pre-Treatment of Anxiety Prior to Cervical Spine Surgery Improves Clinical Outcomes: A prospective Single Institutional Experience.
Affective disorders such as depression and anxiety have been shown to contribute to inferior outcomes after spine surgery. A high baseline level of anxiety is associated with refractory postoperative pain and patient dissatisfaction with surgery. The aim of this prospective study is to assess whether the pretreatment of anxiety before spine surgery improves patient reported outcomes 1-year after an anterior cervical discectomy and fusion (ACDF) procedure. ⋯ Our study demonstrates that pretreatment of anxiety before cervical spine surgery results in a significant reduction in postoperative neck pain scores and may be a viable management strategy for patients with coexisting affective disorders and cervical spine pathology. Patients awaiting spine surgery should routinely be assessed for anxiety before surgery, and interventions to reduce and treat anxiety should be provided.
-
Observational Study
Surgery for acute subdural haematoma: replace or remove the bone flap?
In surgery for acute subdural hematoma (ASDH), the bone flap can be fixed onto the skull, left riding to provide partial skull decompression, or removed. This study assessed whether removing the bone flap improved outcome. ⋯ Our study concluded that removing the bone flap after ASDH evacuation was not associated with a better outcome. We recommend replacing the bone flap if brain conditions allow. Further research is required to evaluate the role of skull decompression in surgery for ASDH.
-
Most of the physician's attention during spinal surgery, when using wires and screws, is toward the avoidance of injuries of critical structures (nerves and vessels). When such wires are broken during surgery, the most important point is to take them out safely or, if it is impossible, to leaf them in secure place and follow the patient closely. Migrations of broken Kirschner wire (K-wire) are well known in literature; however, to the best of our knowledge, migration of a fractured K-wire during anterior atlantoaxial fixation of cervical spine has not been reported in the literature. ⋯ Our recommendation is to inspect the K-wire before using it and to try retrieve as much as possible when removing it.