Acta neurochirurgica
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Acta neurochirurgica · Apr 2011
Comparative StudyChallenging reconstructive techniques for skull base defect following endoscopic endonasal approaches.
We assessed the outcomes of various reconstructive methods for skull base defect after endoscopic endonasal approaches (EEA) depending on the degree of intraoperative cerebrospinal fluid (CSF) leaks. ⋯ The selection of reconstructive methods for skull base defects should be determined by the degree of CSF leaks. Although grade 0 or 1 leak requires relatively conservative management such as simple closure or free-tissue grafting, a more aggressive reconstructive technique is required to prevent postoperative complication in grade 2 CSF leak.
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Acta neurochirurgica · Apr 2011
Case ReportsEndovascular treatment of complex intracranial aneurysms using intra/extra-aneurysmal stent.
Intra/extra-aneurysmal stent placement for treatment of complex and wide-necked bifurcation aneurysms has been previously described. However, this technique has been rarely reported in the treatment of dissecting aneurysms with incorporated vessels. We assess the feasibility and effectiveness of intra/extra-aneurysmal stent-assisted coil embolization in the treatment of those complex intracranial aneurysms. ⋯ Intra/extra-aneurysmal stent placement and subsequent coil embolization may be effective for the treatment of selected patients with complex intracranial aneurysms. Short-term follow-up data indicate good durability of stent-assisted aneurysm occlusion. However, further study with longer follow-up and larger case series is necessary for validation of the efficacy of this treatment modality.
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Acta neurochirurgica · Apr 2011
ReviewPulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications-a review.
The objective of this review is to evaluate the efficacy of Pulsed Radiofrequency (PRF) treatment in chronic pain management in randomized clinical trials (RCTs) and well-designed observational studies. The physics, mechanisms of action, and biological effects are discussed to provide the scientific basis for this promising modality. ⋯ From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regards to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the methodological quality of the included study. PRF application to the supracapular nerve was found to be as efficacious as intra-articular corticosteroid in patients with chronic shoulder pain. The use of PRF in lumbar facet arthropathy and trigeminal neuralgia was found to be less effective than conventional RF thermocoagulation techniques.
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Acta neurochirurgica · Apr 2011
Onyx embolization for the treatment of brain arteriovenous malformations.
Onyx has emerged in recent years for the endovascular treatment of brain arteriovenous malformations (AVMs). However, the role of Onyx embolization is still under discussion. We report our initial experiences in the treatment of brain AVMs with Onyx embolization. ⋯ Although Onyx allows moderate obliteration rates, combined management, such as adjunctive embolization with microsurgery or radiosurgery, may be effective for selected large AVMs.