Acta neurochirurgica. Supplement
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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.
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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°).
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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.
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Acta Neurochir. Suppl. · Jan 2011
Review Historical ArticleA clinical review of cerebral vasospasm and delayed ischaemia following aneurysm rupture.
The continuation of a review of delayed vasospasm after aneurysmal subarachnoid haemorrhage, originally published in 1994 and partially updated at the ninth vasospasm conference in Turkey, is presented. Further online and physical searches have been made of the relevant literature. The incidence of delayed ischaemic deficit (DID) or symptomatic vasospasm reported in 1994 was 32.5% in over 30,000 reported cases. ⋯ It thus appears likely that delayed vasospasm is still common but less so, and that the overall outcome has improved. This may be due to the more widespread use of calcium antagonists and more effective fluid management. A number of other mechanical and drug treatments are also mentioned.
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Chronic subdural hematoma (CSDH) is a common neurosurgical condition that has a high incidence in the increasing elderly population of many countries. Pathologically, it is defined as a persistent liquefied hematoma in the subdural space more than 3 weeks old that is generally encased by a membraneous capsule. CSDHs likely originate after minor head trauma, with a key factor in its development being the potential for a subdural cavity to permit its expansion within, which is usually due to craniocerebral disproportion. ⋯ Current belief is that CSDH arises from recurrent bleeding in the subdural space, caused by a cycle of local angiogenesis, inflammation, coagulation and ongoing fibrinolysis. However, because of a lack of detailed knowledge about the precise mechanisms, treatment is often limited to surgical interventions that are invasive and often prone to recurrence. Thus, it is possible that an easily reproducible and representative animal model of CSDH would facilitate research in the pathogenesis of CSDH and aid with development of treatment options.