World Neurosurg
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Cervical anterior fusion with autologous bone grafts (Williams-Isu method) is a modified, accepted method to treat spinal degenerative disease. Here we report minimum 10-year outcomes. ⋯ The long-term results after the Williams-Isu method were good. The fused segment angle loss of approximately 6° did not affect long-term outcomes although it did affect sagittal cervical alignment. Postoperative worsening of the fused segment angle and hyper ROM changes in the adjacent level were not related to the need for reoperation in our study.
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With the use of fluorescence-guided resection with 5-aminolevulinic acid (5-ALA), the rate of complete resection of the contrast-enhancing part of malignant gliomas could be increased from 36% to 65%. Because the visualization of 5-ALA-induced fluorescence depends on a sufficient exposure to fluorescent light, residual tumor tissue in deep-seated resection cavities might not be detected. In addition, subcortical parts of a large spherical tumor might not be visualized, owing to a tangential position at the periphery of the microscopic field. With the availability of a specially designed endoscope with the capability to visualize 5-ALA fluorescence, we investigated the impact of this new technique on the visualization of residual glioma tissue. ⋯ As an additional instrument, fluorescence-guided endoscopic visualization might help to overcome technical limitations of the conventional microscopic exposure of 5-ALA-positive tumor tissue. The false-positive 5-ALA tissue indicates that endoscopic visualization may overestimate the amount of tumor, so further analyses to ascertain the sensitivity and specificity of this technique are required.
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Biography Historical Article
The Clinic of Neurosurgery at the Clinical Center of Serbia in Belgrade--building on the past.
Neurosurgery as an independent discipline in Serbia has a distinguished history, beginning in 1938 when Dr. Milivoje Kostic, Professor and Chairman of Surgery, opened the Department of Neurosurgery within the Clinic of Surgery in Belgrade. Since then, thanks to the founding fathers' efforts and their successors' work, the Clinic for Neurosurgery in Belgrade has become a highly specialized health, scientific, and educational institution that is part of the University of Belgrade and is a referral center for all neurosurgical clinics in Serbia. ⋯ Each year, there are more than 3000 admissions at the neurosurgical service. Approximately 3500 operations per year are performed in the main campus neurosurgical operating rooms of CCS, while approximately 15,000 patients alone are evaluated in emergency room or inpatient consultations. Despite economic restraints, the department continues to grow in strength, and we remain optimistic of exciting times ahead for neurosurgery at the CCS.
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Basilar artery apex aneurysms continue to generate technical challenges and management controversy. Endovascular intervention is becoming the mainstay in the management of these formidable aneurysms, but it has limitations, especially with large/giant or wide neck basilar apex aneurysms. There is paucity of data in the available literature pertaining to the successful management of large/giant, wide neck, and calcified/thrombosed basilar apex aneurysms. We present our experience with consecutively operated complex basilar apex aneurysms so as to present the role of microneurosurgery as a viable management option for these aneurysms. ⋯ Although concerning, the management of large/giant, wide neck, and calcified/thrombosed aneurysms with microneurosurgery is still a competitive alternative to endovascular therapy. After careful selection of appropriate skull base approaches based on the complexity of the basilar apex aneurysm, microneurosurgery can achieve acceptable results.
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Case series have identified that de novo intracranial aneurysms occur. However, the risk for this occurrence has not been established. We examined the risk for the de novo intracranial aneurysm detection in a consecutive surgical case series. ⋯ There is a 10-year de novo aneurysm detection rate of between 10% and 16% after surgery. Smoking increases the risk of de novo aneurysm detection. Consideration needs to be given to surveillance angiography after aneurysm treatment.