Acta neurochirurgica
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Acta neurochirurgica · Jul 2008
Case ReportsTrigemino-cardiac reflex in humans initiated by peripheral stimulation during neurosurgical skull-base operations. Its first description.
The trigemino-cardiac reflex (TCR) is a well-recognised phenomenon (first described in skull base surgery by the authors in 1999) that consists of bradycardia, arterial hypotension, apnoea, and gastric hypermobility. TCR occurs during skull base surgery at or around structures that are innervated by any sensory branch of the trigeminal nerve. Thus far, it has not been shown that peripheral stimulation of a trigeminal nerve can also cause this reflex. ⋯ We present the first report of peripheral stimulation of a sensory branch of the trigeminal nerve that leads to a TCR under general anaesthesia according to our strict criteria as defined in 1999. The present finding is therefore a key research development and gives substantial evidence that TCR is coincident enhancement of sympathetic and parasympathetic outflows to the heart, suggesting that genetic differences may affect the susceptibility for TCR.
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Acta neurochirurgica · Jul 2008
Comparative StudyComputed tomographic angiography in the evaluation of clip placement for intracranial aneurysm.
Computed tomographic angiography (CTA) has been shown to reliably detect aneurysms pre-operatively. The aim of this study was to compare the ability of post-operative CTA to detect aneurysmal remnants in connection with clip placement compared with digital subtraction angiography (DSA). Furthermore, special attention was paid to identifying factors influencing the image quality of CTA. ⋯ Post-operatively, CTA can be recommended as a reliable non-invasive diagnostic tool only with optimal image quality and with this criterion up to 66% of the aneurysms can be evaluated. Titanium artefacts, especially in the important zone (<2 mm) around the clip in which small aneurysmal remnants can occur, can render adequate evaluation impossible. CTA image quality depends on the number of titanium clips used, but clip-gantry-angle does not significantly influence the image quality.
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Acta neurochirurgica · Jul 2008
Anterior clinoidal meningiomas: analysis of 43 consecutive surgically treated cases.
Anterior clinoidal meningiomas are considered different from meningiomas of the medial sphenoid wing, but there is still some confusion about identification. The current classification scheme only considers tumour origin and invasion pattern around the clinoid process as indicators of resectability. However, the size of the tumour has important effects on surgical outcome. The purpose of this study was to analyze our clinical experience with anterior clinoidal meningiomas and refine the current classification scheme. ⋯ Anterior clinoidal meningioma is a separate disease entity from other meningiomas of the medial third of the sphenoid wing. Relatively good outcomes can be stated in this specific subgroup if growth criteria competable with true diagnosis are fulfilled. Size should be incorporated into any classification scheme for determining clinical and surgical risk. The standard pterional approach is sufficient for removing anterior clinoidal meningiomas.
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Acta neurochirurgica · Jul 2008
Case ReportsIntrathecal chemotherapy delivered by a lumbar-thecal catheter in metastatic medulloblastoma: a case illustration.
Medulloblastoma is the most common malignant brain tumour in children. Despite recent advances, the prognosis in high risk patients remains poor. Further improvement in survival is dependent upon the development of strategies to attack the tumour more effectively, but with less toxicity. Intrathecal chemotherapy, is an ideal but currently underused method of directly targeting residual tumour within the area of resection and the leptomeningeal disease commonly associated with this tumour. ⋯ This method represents a simple, safe and effective method of delivering an even and widespread distribution of drug within the cerebrospinal fluid (CSF) of the neuroaxis. With new agents being identified and others in the early stages of development, intrathecal chemotherapy may emerge as an important therapeutic option to consider when faced with such challenging cases.
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Acta neurochirurgica · Jul 2008
Comparative StudyComparison of CT characteristics of extravertebral cement leakages after vertebroplasty performed by different navigation and injection techniques.
This study was intended to assess the results of post-operative CT scans in three groups of patients following percutaneous vertebroplasty (VP) using different navigation and injection methods, in an attempt to explain the radiological characteristics of extravertebral cement leakage with relation to needle placement and focused on the ventral epidural accumulation of bone cement. Furthermore, we have suggested a morphological (and functional) classification of the types of cement leakage. ⋯ The incidence of epidural accumulation of bone cement may be concluded to be closely correlated with the position of the tip of the needle. Centrally injected bone cement may easily invade into the basivertebral system, and the material can then be transferred via these veins toward the ventral epidural space, and result in canal compromise and/or compression of the neural elements. The results of statistical analysis (Chi-square test) revealed that injection of bone cement into the lateral third of the vertebral body significantly decreases the extent of ventral epidural leakage. Therefore, a strictly lateral injection is advised, when the tip of the needle is placed into the lateral third of the vertebral body. Frameless stereotaxy navigation improves achievement of accurate needle placement and decreases the frequency of ventral epidural leakage. It is a safe and very accurate method for positioning of the injecting needles.