Minimally invasive neurosurgery : MIN
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Minim Invasive Neurosurg · Apr 2010
Surgical repair of persisting CSF leaks following standard or extended endoscopic transsphenoidal surgery for pituitary tumor.
In this article, the aim of the authors is to discuss their experience with skull base reconstruction in endoscopic transsphenoidal and extended transsphenoidal surgery for pituitary tumor resection. ⋯ More complex defects after pituitary surgery should be repaired with a multilayer technique, using autologous materials such as fat, fascia lata, bone and mucoperiosteum taken from the middle turbinate. This type of autologous material is generally reliable in more complex defects, and it appears to be easy to harvest and handle for repair.
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Minim Invasive Neurosurg · Apr 2010
Comparative StudyComparison of unilateral hemilaminotomy and bilateral hemilaminotomy according to dural sac area in lumbar spinal stenosis.
Unilateral hemilaminotomy (ULH) and/or bilateral hemilaminotomy (BLH) with limited facetectomy are defined approaches to decompress the thecal sac and exiting lumbar nerve roots without increasing the risk of subsequent spinal instability. ⋯ A unilateral approach with bilateral decompression and bilateral approach with bilateral hemilaminotomy are both minimal invasive, adequate and safe approaches with excellent prognosis. However, BLH leads to a bigger expansion of DSA.
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Minim Invasive Neurosurg · Apr 2010
Continuous monitoring of intracranial pressure after endoscopic third ventriculostomy in the management of CSF shunt failure.
The effectiveness of continuous intracranial pressure (ICP) monitoring in the adaptation period, after endoscopic third ventriculostomy (ETV), and removal of the failed shunt in the management of CSF shunt failure is assessed. ⋯ Post-operative continuous ICP monitoring and EVD insertion were very useful in the treatment of CSF shunt failure with ETV. This procedure allowed intermittent CSF drainage, relieving symptoms of elevated ICP, and provided accurate assessment of the success of the ETV and patency of the stoma in the early postoperative days by CT ventriculography and can also be used to install antibiotics in cases of infection.
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Minim Invasive Neurosurg · Feb 2010
The supraorbital craniotomy for access to the skull base and intraaxial lesions: a technique in evolution.
The supraorbital craniotomy was initially described as a minimally invasive means to target extra-axial lesions in the anterior cranial fossa and sellar/parasellar region. Since its initial description, various modifications have been described. We report our recent experience with this approach (and its modifications) for not only extra-axial but also intra-axial neoplastic pathology. ⋯ The supraorbital craniotomy and its modifications provide an ideal anterior subfrontal approach through which a wide variety of pathology can be approached. This technique has particular considerations in comparison to traditional cranial base approaches that must be taken into account before it is utilized.
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Minim Invasive Neurosurg · Feb 2010
Case ReportsStaged use of the transsphenoidal approach to resect superior third ventricular craniopharyngiomas.
Craniopharyngiomas are benign tumors, usually originating from the infundibulum or tuber cinereum. Their surgical treatment is challenging because of their relationship to neural and vascular structures. Large craniopharyngiomas that invade the upper third of the third ventricle are a common reason for patients to need a second operation to accomplish a gross total resection. Transsphenoidal approaches are being increasingly used in the treatment of craniopharyngiomas. Large craniopharyngiomas involving the superior third ventricle are most commonly resected through a staged approach, often involving a transcortical or interhemispheric route. ⋯ The authors find this to be an excellent indication for an endoscopic extended transsphenoidal approach in selected cases.