Acta neurochirurgica
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Recent high-tech innovations in digital surgical technology have led to advances in three-dimensional (3D) and high-definition (HD) operating scopes. We introduce a novel 3D-HD flexible surgical scope called "3D-Eye-Flex" and evaluate its utility as an alternative to the operating microscope. ⋯ This novel 3D-HD flexible scope is an effective alternative to the operating microscope as a new surgeon's eye and will be suitable for digital image-based surgery with further refinement.
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Acta neurochirurgica · Jun 2014
Microvascular decompression for trigeminal neuralgia using the 'Stitched Sling Retraction' technique in recurrent cases after previous microvascular decompression.
Microvascular decompression is a well-known therapeutic option for trigeminal neuralgia. It is considered safe and effective, and is the surgical treatment of choice for the malady. However, there is no standard technique for it and different authors have proposed different techniques of performing it. In this study, we observe the clinical results of the so-called 'stitched sling retraction' technique for recurrent cases of trigeminal neuralgia. ⋯ The 'stitched sling retraction' technique shows promising preliminary results in recurrent cases of trigeminal neuralgia after previous microvascular decompression(s). Since it is a 'transposing' technique, it might be associated with less recurrence rates (due to resuming of the neurovascular conflict) than the classic interposing technique, which uses a prosthesis between the offending vessel and the trigeminal nerve.
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Acta neurochirurgica · Jun 2014
Modified open-door laminoplasty for the surgical treatment of cervical spondylotic myelopathy in elderly patients.
The authors describe their experience with a modified version of the standard technique of open-door laminoplasty for the surgical treatment of spondylotic myelopathy in elderly patients with temporary removal of the laminae, extensive decompression, and pre-plating of the laminae beyond the surgical field. ⋯ Transection of the laminae on both sides (temporary laminectomy) and pre-plating of the laminae outside of the surgical field has several advantages: better decompression of the spinal canal and the neuroforamina on both sides, easier undercutting of adjacent vertebral arches for cranio-caudal decompression, and no risk of spinal cord injury by the screwdriver when attaching plates to the laminae.
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Awake craniotomy is a valuable procedure since it allows brain mapping and live monitoring of eloquent brain functions. The advantage of minimizing resource utilization is also emphasized by some physicians in North America. Data on how well an awake craniotomy is tolerated by patients and how much stress it creates is available from different studies, but this topic has not consequently been summarized in a review of the available literature. Therefore, it is the purpose of this review to shed more light on the still controversially discussed aspect of an awake craniotomy. ⋯ For selected patients, an awake craniotomy presents the best possible way to reduce the risk of surgery related neurological deficits. However, benefits and burdens of this type of procedure should be carefully considered when planning an awake craniotomy and the decision should serve the interests of the patient.
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Acta neurochirurgica · Jun 2014
Microvascular decompression in patients with coexistent trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia.
Trigeminal neuralgia(TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GPN) were referred to hyperactive dysfunction syndromes (HDSs) of the cranial nerves. These symptoms may occur synchronously or metachronously, but the combination of three diseases is extremely rare. ⋯ The combination of HFS-TN-GPN is extremely rare and is often associated with a looped VBA and a smaller posterior fossa. However, MVD is still a good choice for treatment. To achieve a safe and effective outcome, dissection of the caudal cranial nerves and proximal transposition of the vertebral artery before decompression of the affected nerve roots are strongly recommended.