World Neurosurg
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Lumbar disc herniation (LDH) is a common spinal problem, with reoperation rates of 6%-24%. Although different surgical techniques are used for treatment, there is still debate regarding whether fusion techniques can reduce the reoperation rate in patients with LDH. ⋯ Among surgical procedures for LDH, fusion techniques are related to lower reoperation rates compared with discectomy, but at the expense of higher medical costs.
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Endoscopic surgery for lumbar stenosis is gaining acceptance because of the minimal muscle damage, short recovery times, reduced blood loss, and good clinical results. We report a novel technique of decompressing contralateral traversing and exiting nerve roots through a single interlaminar window, avoiding separate incision for foraminal decompression with minimal damage to facet joints and comparing morphometric changes after decompression. ⋯ Biportal endoscopic decompression of the lateral recess and cranial foramen through a single interlaminar window can be performed using a contralateral approach. In view of the good clinical and radiologic outcomes of patients, with notable improvements in morphometric measurements at stenosed segments, this surgical technique is worthy of further evaluation and application.
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Skin complications are a frequent type of complication of deep brain stimulation (DBS) neurosurgical procedure and are always observed in the postauricular area, scalp area, and implantable pulse generator pocket. Modifications to the surgical techniques for DBS have been proposed as therapeutic options. To prevent skin complications, we modified the surgical incisions. ⋯ By trying to avoid placing hardware directly under the suture line, our modified surgical incision successfully reduces the incidence of skin complications.
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Giant ruptured paraclinoid aneurysm with concomitant bilateral internal carotid artery dissection (CAD) can be a difficult condition to treat with current surgical and endovascular techniques. Paraclinoid internal carotid artery (ICA) aneurysms remain a major challenge for vascular neurosurgeons. There are still controversies in the management of carotid artery (CA) dissections. Surgical and endovascular treatment is recommended in cases with multivessel dissections or those complicated by subarachnoid hemorrhage (SAH). ⋯ Dealing only with the ruptured paraclinoid aneurysm, without taking care of the underlying cerebral ischemia owing to concomitant extracranial ICA dissection, could be an insufficient approach for treatment. In the presented case of a giant ruptured paraclinoid aneurysm and coexistence of severe bilateral ICA dissecting stenosis, trapping with matching the bypass flow was the proper solution for managing simultaneously with the aneurysm and the cerebral ischemia from the left side. Anticoagulants and antiplatelets were applied safely to treat the right internal CAD.
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Ventriculitis is a serious complication when using external ventricular drains (EVDs). Bactericidal silver coating has been reported to reduce risk of infection. In the clinical setting, the diagnosis is often made based on symptoms and analyses of cerebrospinal fluid, with treatment initiated before infection is verified by culture. The bactericidal effect might not correlate with a reduced rate of clinically diagnosed infections. This retrospective study aimed to analyze if use of silver-coated EVDs is associated with a reduced rate of ventriculitis. ⋯ The previously reported bactericidal effect of silver-coated EVDs did not alter the clinical course to significantly reduce the number of treated cases of ventriculitis. The introduction of silver-coated EVDs cannot be motivated by reduced use of antibiotics or shorter hospital stay.