World Neurosurg
-
Incidental durotomy, a known complication of spinal surgery, can lead to persistent cerebrospinal fluid leak and pseudomeningocele if unrecognized or incompletely repaired. We describe the use of ultrasound to visualize the site of durotomy, observe the aspiration of the pseudomeningocele, and guide the precise application of an ultrasound-guided epidural blood patch (US-EBP), under direct visualization in real time. ⋯ This manuscript represents the largest series in the literature describing US-EBP for the treatment of postoperative pseudomeningocele. The success rate suggests that routine utilization of US-guided EBP may allow for targeted treatment of pseudomeningoceles, without the prolonged hospitalization associated with lumbar drains or the risks of general anesthesia and impaired wound healing associated with surgical revision.
-
We investigated the role of a self-retaining retractor system, commonly used in ear, abdominal, vascular, urologic and gynecologic surgeries: the Lone Star retractor system. We report our experience in using the Lone Star retractor in different brain surgeries, at a single neurosurgical department. ⋯ In our institutional experience, the Lone Star retractor showed many advantages in different brain procedures, when compared with standard fishhooks and other retractors.
-
Presacral abscess is a common disease in the developing countries. Treatments include minimally invasive percutaneous drainage and open surgical debridement. Percutaneous drainage under computed tomography (CT) guidance has been recommended by the American College of Radiology as a good alternative to surgical drainage before elective surgical treatment. Because of the many anatomic obstacles, the presacral space can be one of the most difficult locations to access. There are several reported access routes like transabdominal, transgluteal, transvaginal, transperineal, transanal, precoccygeal, transpedicular, and so on. We introduce a novel approach, the trans-sacral-foramen approach, to drain presacral abscess under CT guidance. ⋯ Trans-sacral-foramen approach is the shortest path to reach the presacral abscess. The approach is easier and safer than the others for patients with indication.
-
Enterprise stents are widely used for intracranial aneurysms located on small arteries (<2.5 mm in diameter) and change the geometry of parent arteries. The purpose of this study was to investigate the correlation between vascular geometry changes and long-term outcomes. ⋯ Enterprise stent-assisted coiling of intracranial aneurysms located on small arteries is safe and effective. Our study found that Enterprise deployment in small arteries had a low procedural complication rate and high stent tolerance. Vascular geometry changes play an important role in aneurysm recanalization.
-
Radiation therapy is a common treatment for meningiomas. Volume changes of meningiomas in response to radiation are not well characterized. This study seeks to quantify the volume change of meningiomas following radiation. ⋯ Meningiomas treated with radiation exhibit nonlinear decrease in size over time. The greatest decrease in tumor volume occurs within the first year and begins to plateau 5 years post-radiation treatment.