Acta neurochirurgica
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Acta neurochirurgica · Oct 2014
Primary dural closure and anterior cranial base reconstruction using pericranial and nasoseptal multi-layered flaps in endoscopic-assisted skull base surgery.
Dural and anterior cranial base reconstruction is essential in the surgical resection of a craniofacial tumor that extends from the paranasal sinuses to the subdural space. Watertight reconstruction of vascularized tissue is essential to prevent postoperative liquorrhea, especially under conditions that prevent wound healing (e.g., postoperative irradiation therapy). ⋯ This multi-layered anterior cranial base reconstruction consisted of three layers: a fascia for dural plasty and double-layered PCF and NSF. This surgical reconstruction technique is suitable to treat craniofacial tumors extending into the subdural space through the anterior cranial base dura mater.
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Acta neurochirurgica · Oct 2014
Neurolysis for secondary sciatic nerve entrapment: evaluation of surgical feasibility and functional outcome.
The study included 11 patients; seven males and four females with mean age of 68.3 ±11 years. All patients had sciatic nerve entrapment: three had a penetrating injury, three suffered postoperative trauma, two had a crush injury, two had inadvertent injections and one was trapped in a machine belt. Clinical examination included: an evaluation of the extent of motor and sensory impacts according to the British Medical Research Council (BMRC) scale and the Semmes-Weinstein monofilament test; assessment of pain sensation using the visual analogue scale (VAS); electromyography; and nerve conduction velocitiey determination. The applied operative procedure for sciatic neurolysis was modulated according to the suspected site of sciatic nerve entrapment. At 6 and 12 months after surgery all patients were evaluated for recovery of motor and sensory function. ⋯ Surgical exploration and neurolysis of cases with sciatic nerve entrapment is a safe and effective therapeutic modality with significant improvement of both motor and sensory functions without risk of additional deficit secondary to neurolysis.
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Acta neurochirurgica · Oct 2014
Reconstruction after retrosigmoid approaches using autologous fat graft-assisted Medpor Titan cranioplasty: assessment of postoperative cerebrospinal fluid leaks and headaches in 60 cases.
Postoperative cerebrospinal fluid (CSF) leaks and headaches remain potential complications after retrosigmoid approaches for lesions in the posterior fossa and cerebellopontine angle. The authors describe a simple repair technique with an autologous fat graft-assisted Medpor Titan cranioplasty and investigate the incidence of postoperative CSF leaks and headaches using this technique. ⋯ Our multilayer repair technique with a fat graft-assisted Medpor Titan cranioplasty appears effective in preventing postoperative CSF leaks and new-onset postoperative headaches after retrosigmoid approaches. Postoperative lumbar drainage may not be necessary.
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Acta neurochirurgica · Oct 2014
Observational StudyIntravenous paracetamol for fever control in acute brain injury patients: cerebral and hemodynamic effects.
Fever occurs frequently in acute brain injury patients, and its occurrence is associated with poorer outcomes. Paracetamol, an antipyretic frequently employed in patients with cerebral damage, may cause hypotension. We evaluated the cerebral and hemodynamic effects of intravenous (IV) paracetamol for the control of fever in Neuro-Intensive Care Unit (NICU) patients. ⋯ Paracetamol administration is effective but exposes patients to hypotensive episodes that must be recognized and treated expeditiously to prevent further damage to the injured brain.
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Acta neurochirurgica · Oct 2014
Usefulness of facial nerve monitoring for confirmation of greater superficial petrosal nerve in anterior transpetrosal approach.
The greater superficial petrosal nerve (GSPN) is especially important in anterior transpetrosal approach (ATPA) as the most reliable superficial landmark of Kawase's triangle. The GSPN can be considered as the superficial lateral border of anterior petrosectomy on the middle fossa to avoid internal carotid artery (ICA) injury. Although experienced operators can find the GSPN, its confirmation is not always easy to achieve. ⋯ GSPN confirmation and preservation are not always easy to achieve. These monitoring methods are useful for the confirmation of the GSPN, which is a landmark for safe extradural anterior petrosectomy, and for the preservation of the GSPN itself.