Acta neurochirurgica
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Acta neurochirurgica · Nov 2015
Application of intraoperative motor evoked potential monitoring during giant internal carotid artery aneurysm surgery using prolonged temporary occlusion.
Clipping and bypass surgery are common therapeutic options for the management of giant internal carotid artery (ICA) aneurysms. However, potential ischemic risks may be exaggerated by prolonged temporary occlusion (PTO) during the surgery. Monitoring motor-evoked potentials (MEPs) is a sensitive technique for detecting potential ischemia intraoperatively. This preliminary study was designed to evaluate the effectiveness of applying MEP monitoring during giant ICA aneurysm surgery using PTO. ⋯ MEP monitoring is useful for evaluating the safety of PTO, surgical strategy, and outcomes of giant ICA aneurysm surgery. Direct clipping during safe PTO under intraoperative MEP monitoring is applicable for giant ICA aneurysms. Its use achieved favorable outcomes by indicating the need for bypass surgery.
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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.
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Acta neurochirurgica · Nov 2015
Adenosine-induced transient asystole during intracranial aneurysm surgery: indications, dosing, efficacy, and risks.
Several flow-arrest techniques have been introduced for the treatment of complex aneurysms that cannot be treated with conventional clipping or endovascular coil embolization. Adenosine-induced transient asystole is an alternative method of flow arrest. However, given the limited number of studies that have reported on this topic, there is no consensus regarding the dose, regimen, efficacy, and potential risks of adenosine. ⋯ In our experience, adenosine-induced transient asystole was safe and helpful for satisfactory clipping of a complicated aneurysm. An estimated dose injection of adenosine was more convenient than the test-incremental method and did not result in serious cardiologic problems.
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Acta neurochirurgica · Nov 2015
Validation of the modified Graeb score in aneurysmal subarachnoid hemorrhage.
Intraventricular hemorrhage (IVH) in patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) is a known negative predictor. Scoring systems like Fisher, Le Roux, and original Graeb score (oGS) are established to quantify the volume of IVH. The aim of this study was to evaluate the validity of the recently introduced modified Graeb score (mGS) in patients with aSAH. ⋯ Our study confirms the validity of the recently introduced mGS to quantify the volume of IVH and extends its value in aSAH. However, the mGS offers no additional predictive value for hospital mortality, development of CHC, and poor early functional outcome in patients with aSAH patients compared to the less complex oGS.