Acta neurochirurgica
-
Acta neurochirurgica · Nov 2015
ReviewVagus nerve stimulation lead removal or replacement: surgical technique, institutional experience, and literature overview.
With the growing use of vagus nerve stimulation (VNS) as a treatment for refractory epilepsy, there is a growing demand for complete removal or replacement of the VNS system. We evaluate the safety and efficacy of complete removal or replacement of the VNS system and provide an extensive description of our surgical technique. ⋯ Complete removal or replacement of the VNS system including lead and coils is feasible and safe. Although initial results seem promising, further research and longer follow-up are needed to assess whether lead replacement may affect VNS effectiveness.
-
Acta neurochirurgica · Nov 2015
Poor diagnostic accuracy of transcranial motor and somatosensory evoked potential monitoring during brainstem cavernoma resection.
Microsurgical resection of brainstem cavernomas carries a high risk of new postoperative morbidity such as cranial nerve, motor and sensory deficits as well as functional deterioration. Intraoperative monitoring is used to avoid impending damage to these highly eloquent tracts. However, data on neurophysiological monitoring during resection of brainstem cavernomas are lacking. ⋯ In continuous MEP and SSEP monitoring during brainstem cavernoma microsurgery, high rates of false-positive and -negative results are encountered, resulting in low positive and relatively high negative predictive values. Careful interpretation of the intraoperative monitoring results is essential in order to avoid potentially unjustified termination of brainstem cavernoma resection.
-
Acta neurochirurgica · Nov 2015
Comparative Study Observational StudyComparison of predictability of Marshall and Rotterdam CT scan scoring system in determining early mortality after traumatic brain injury.
Marshall computed tomographic (CT) classification is widely used as a predictor of outcome. However, this grading system lacks the following variables, which are found to be useful predictors: subarachnoid/intraventricular hemorrhage, extradural hematoma, and extent of basal cistern compression. A new classification called the Rotterdam grading system, incorporating the above variables, was proposed later. In the original paper, this system was found to have superior discrimination as compared to Marshall grading, however, Rotterdam grading has not been validated widely. We aimed to compare the discriminatory power of both grading systems. ⋯ Both Marshal and Rotterdam grading systems are good in predicting early mortality after moderate and severe TBI. As the Rotterdam system also includes additional variables like subarachnoid hemorrhage, it may be preferable, particularly in patients with diffuse injury.
-
Acta neurochirurgica · Nov 2015
Case ReportsSpecific and helpful intraoperative indocyanine green videoangiography finding of blood blister-like aneurysm of internal carotid artery.
Blood blister-like aneurysms (BBAs) account for 0.5-2.0 % of ruptured intracranial aneurysms. Because of their rarity, the natural history and pathophysiology of such aneurysms are not fully understood. We present two patients with BBAs treated with Bemsheets-covered clipping and discuss their pathophysiological characteristics, through the intraoperative and specific indocyanine green (ICG) video angiography (VA) findings. ⋯ ICG-VA showed the filling defect of dye in BBAs, which supported that BBAs have been a pseudoaneurysm. In addition, although not routinely recommended in the treatment of BBAs, we believe that Bemsheet-covered clipping is a safe and effective treatment option for BBAs.
-
Acta neurochirurgica · Nov 2015
Case ReportsVertebral artery injury during foraminal decompression in "low-risk" cervical spine surgery: incidence and management.
Vertebral artery injury (VAI) during foraminal decompression in cervical spine surgery in the absence of repositioning or screw stabilization is rare. Without immediate recognition and treatment, it may have disastrous consequences. We aimed to describe the incidence and management of iatrogenic VAI in low-risk cervical spine surgery. ⋯ In a high-volume surgical center, the incidence of VAI during low-risk cervical spine surgery is extremely low, comprising 0.3 % of all cases. The major risks are delayed sequels of the vessel wall laceration. In cases of VAI, immediate angiographic diagnostics and generous indications for endovascular treatment are obligatory.