Acta neurochirurgica. Supplement
-
Acta Neurochir. Suppl. · Jan 2011
ReviewSurgical anatomy of the sacral hiatus for caudal access to the spinal canal.
The sacral hiatus is used for access to the spinal canal in many neurosurgical and anesthesiologic procedures. The aim of the present paper is to give a review of its anatomical characteristics relevant to permit correct and uncomplicated accesses. ⋯ The mean sacral space depth has been observed to be 4.6 mm in adults and 3.5 mm in infants. On the basis of anatomical measurements of the sacral hiatus, lower insertion angles have been suggested in infant with respect to adult subjects (21° vs. 58°).
-
Acta Neurochir. Suppl. · Jan 2011
ReviewPeriduroscopy: general review of clinical features and development of operative models.
Myeloscopy is a useful approach for both diagnosis and treatment of back pain. However clinicians have underestimated its potential. From the nineties myeloscopy has been used only as a diagnostic tool, without any improvement of the technique. Racz's method is nowadays still used for the lysis of adherence by applying medical solutions without a direct vision inside the spinal channel. In 1998 we showed the limitations of Racz's approach, and in 1999 we developed a new technique, introducing a Fogarty balloon to remove the occlusions of the spinal canal and the resaflex for the lysis of adherence at low temperature (Raffaeli-Righetti technique). In this paper we report a general review of our experience with periduroscopy for the treatment of failed back surgery syndrome (FBSS) and spinal stenosis. ⋯ myeloscopy technique enlightens pain-triggering mechanisms otherwise unrevealed; it has specific therapeutic value, whereas on the diagnostic side it has not revealed relevant pathologies. Its effectiveness in FBSS patients is high, with the advantage of its relatively easy implementation, limited invasiveness and repeatability.
-
Acta Neurochir. Suppl. · Jan 2011
Review Randomized Controlled TrialIntravenous magnesium sulfate after aneurysmal subarachnoid hemorrhage: current status.
Delayed ischemic neurological deficit or clinical vasospasm remained a major cause for delayed neurological morbidity and mortality for patients with aneurysmal subarachnoid hemorrhage (SAH). Magnesium is a cerebral vasodilator. In experimental model of drug or SAH-induced vasospasm, magnesium blocks voltage-dependent calcium channels and reverses cerebral vasoconstriction. ⋯ Using random effects model (Mantel-Haenszel, Robins-Breslow-Greenland), the pooled odds ratio for symptomatic vasospasm or delayed cerebral ischemia is, 0.620, 95% CI 0.389-0.987, statistically significant. Similarly, the pooled odds ratio for favorable outcome is 1.598, 95% CI 1.074-2.377, statistically significant. There are two multi-center phase III studies (IMASH and MASH2) being carried out to assess the clinical effects, in which IMASH has finished data collection on 30th June 2009.
-
The extradural space is currently investigated through fluoroscopy and ultrasound for surgical approach, whereas magnetic resonance imaging has been used to provide detailed information. The aim of the present paper is to describe the radiologic anatomy of the sacral canal through a review of its appearance in the different radiologic techniques. CT is able to visualise also the sacrum and the content of the sacral canal, triangular in shape in the transverse images, being able to establish the measurement of the transverse area of the dural sac and of the canal diameter. ⋯ The band-like structure on top is the sacrococcygeal ligament. The band-like structure at the bottom is the dorsal surface of the sacrum. The sacral hiatus corresponds to the hypoechoic region observed between the two hyperechoic band-like structures.
-
Acta Neurochir. Suppl. · Jan 2011
ReviewComparison of different preclinical models of intracerebral hemorrhage.
Intracerebral hemorrhage (ICH) is the most devastating type of stroke. It is characterized by spontaneous bleeding in brain parenchyma and is associated with a high rate of morbidity and mortality. Presently, there is neither an effective therapy to increase survival after intracerebral hemorrhage nor a treatment to improve the quality of life for survivors. ⋯ The "balloon" method has also been used to mimic ICH for study. In this summary, we intend to provide a comparative overview of the technical methods, aspects, and pathologic findings of these types of ICH models. We will also focus on the similarities and differences among these rodent models, achievements in technical aspects of the ICH model, and discuss important aspects in selecting relevant models for study.