Acta neurochirurgica
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Acta neurochirurgica · Mar 2015
Comparative StudyAccuracy of subthalamic nucleus targeting by T2, FLAIR and SWI-3-Tesla MRI confirmed by microelectrode recordings.
Successful deep brain stimulation is mostly dependent on accurate positioning of the leads at the optimal target points. We investigated whether the identification of the subthalamic nucleus in T2-weighted 3-T MRI, fluid-attenuated inversion recovery 3-T MRI and susceptibility-weighted 3-T MRI is confirmed by intraoperative neurological microelectrode recording. ⋯ The susceptibility-weighted 3-T MRI-based subthalamic nucleus localization shows the best accuracy compared with T2-weighted and fluid-attenuated inversion recovery 3-T MRI. Therefore, the susceptibility-weighted 3-T MRI should be preferred for surgical planning when the operation procedure is performed under general anesthesia without microelectrode recordings.
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Acta neurochirurgica · Mar 2015
Comparative StudyComparison of indocyanine green fluorescent angiography to digital subtraction angiography in brain arteriovenous malformation surgery.
The potential utility of intraoperative microscope-integrated indocyanine green (ICG) fluorescence angiography in the surgery of brain arteriovenous malformations (AVMs) and evaluation of the completeness of resection is debatable. Postoperative catheter angiography is considered the gold standard. We evaluated the value of ICG and intraoperative catheter angiography in this setting. ⋯ Although ICG angiography is a helpful adjunct in the surgery of some brain AVMs, it's yield in detecting residual AVM nidus or shunt is low, especially for deep-seated lesions and higher grade AVMs. ICG angiography should not be used as a sole and/or reliable technique. High-resolution postoperative angiography must be performed in brain AVM surgery and remains the best test to confidently confirm complete AVM resection.
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Acta neurochirurgica · Mar 2015
Complications of cranioplasty using a bone flap sterilised by autoclaving following decompressive craniectomy.
Increasing use of decompressive craniectomies has led to a corresponding number of cranioplasties performed to replace the subsequent bone defect created. We aimed to evaluate the morbidity associated with cranioplasty using an autologous bone flap sterilised in an autoclave. ⋯ Reimplantation of the autoclaved autologous bone flap following decompressive craniectomy is a simple and cheep alternative to other techniques and is available to any institution that provides autoclaving sterilisation services. This method is associated with a low rate of surgical site infection, but with a significant rate of the bone flap resorption.
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Acta neurochirurgica · Mar 2015
Updated periodic evaluation of standardized neurointensive care shows that it is possible to maintain a high level of favorable outcome even with increasing mean age.
Periodic evaluation of neurointensive care (NIC) is important. There is a risk that quality of daily care declines and there may also be unrecognized changes in patient characteristics and management. The aim of this work was to investigate the characteristics and outcome for traumatic brain injury (TBI) patients in the period 2008-2009 in comparison with 1996-1997 and to some extent also with earlier periods. ⋯ A large-proportion favorable outcome was maintained despite that patients >60 years with poorer prognosis doubled, indicating that the quality of NIC has increased or at least is unchanged. More surgery may have contributed to maintaining the large proportion of favorable outcome. For future improvements, more knowledge about TBI management in the elderly is required.
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Acta neurochirurgica · Mar 2015
Burr hole is not burr hole: technical considerations to the evacuation of chronic subdural hematomas.
The organization of a multicenter survey about chronic subdural hematomas has triggered the discussion on different surgical techniques of burr hole evacuation. Such a standard operation gives neurosurgeons plenty of scope for creating their own way. ⋯ We present a thorough summary that could serve as a common standard and as a basis for comparison of future trials.