World Neurosurg
-
We retrospectively analyzed and report the clinical results of percutaneous endoscopic lumbar discectomy (PELD) in treating patients with calcified lumbar intervertebral disc herniation (CLDH). ⋯ With the application of Peak philosophy, PELD is safe and effective in treating patients with CLDH. The use of PELD results in good neurological recovery, pain relief, and a low incidence of complications.
-
Comparative Study
Computed Tomography Myelosimulation Versus Magnetic Resonance Imaging Registration to Delineate the Spinal Cord During Spine Stereotactic Radiosurgery.
Underestimation of the spinal cord's volume or position during spine stereotactic radiosurgery can lead to severe myelopathy, whereas overestimation can lead to tumor underdosage. Spinal cord delineation is commonly achieved by registering a magnetic resonance imaging (MRI) study with a computed tomography (CT) simulation scan or by performing myelography during CT simulation (myelosim). We compared treatment planning outcomes for these 2 techniques. ⋯ Significant spatial, rather than volumetric, differences were found between the MRI- and myelosim-defined spinal cord structures. Tumor coverage was compromised with MRI-based planning, and the high spinal cord doses were a concern. Future work is necessary to compare thin-cut, volumetric MRI registration or MRI simulation with myelosim.
-
Next-day postoperative computed tomography (CT) has been routinely used to obtain radiographic "clearance" for transferring patients after elective craniotomy out of the intensive care unit. The value of this traditional policy, however, has repeatedly been questioned. However, the limited patient numbers might have underestimated the very rare, but catastrophic, events. Therefore, we analyzed the value of routine postoperative CT in a larger cohort of elective tumor, epilepsy, and vascular cases. ⋯ Routine postoperative CT did not reveal 1 patient with a serious hematoma that would not have been identified by clinical examination. Patients could be transferred safely from the intensive care unit, if the weaning process and clinical observation findings were uneventful, without deterioration of neurological symptoms or consciousness.
-
The purpose of this study is to introduce our initial experience with the evaluation of the feasibility of using Willis covered stents (WCSs) in the treatment of complicated ophthalmic artery (OA) segment aneurysms. ⋯ WCSs may provide an alternative solution for treating complex OA segment aneurysms by reconstruction and preservation of the ICA. Our study also confirms the safety, efficacy, and midterm durability of WCSs for complex OA segment aneurysms.
-
Patients with hydrocephalus secondary to third ventricular colloid cysts can require bilateral external ventricular drain (EVD) placement while awaiting surgery. However, some patients could develop auto-fenestration of the septum pellucidum (AFSP) and only require 1 EVD. We evaluated our experience with bedside iohexol ventriculography and staged EVD placement for patients with obstructive hydrocephalus. ⋯ A subset of patients with obstruction at the foramina of Monro can develop AFSP. Iohexol ventriculography after unilateral EVD placement allows clinicians to assess for the presence of AFSP and identify patients who can be treated with a single EVD before surgery.