Acta neurochirurgica
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Acta neurochirurgica · Jul 2012
Comparative StudyA comparison of unilateral laminectomy with bilateral decompression and fusion surgery in the treatment of grade I lumbar degenerative spondylolisthesis.
Although unilateral laminectomy and bilateral decompression (ULBD) is effective in the treatment of degenerative spondylolisthesis (DSPL), few reports have compared the outcomes of ULBD and instrumented fusion for the treatment of DSPL. We describe here the clinical and radiological outcomes of ULBD and instrumented fusion surgery for the treatment of DSPL after a minimum 3-year follow-up. ⋯ Our findings suggest that ULBD is the recommendable procedure for the treatment of patients with grade I DSPL who have mainly radicular pain. Although the two groups showed similar clinical outcomes overall, radiological degeneration was not as serious after ULBD treatment. In our analysis, foraminal stenosis is a contraindication for ULBD in the treatment of grade I DSPL.
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Acta neurochirurgica · Jul 2012
Long-term follow-up results in 142 adult patients with moyamoya disease according to management modality.
To clarify the most beneficial treatment of the management modality based on our experience with adult moyamoya disease (MMD). ⋯ Revascularization surgery was effective in further ischemic stroke prevention to a statistically significant extent. Direct and combined bypasses were more effective to prevent recurrent ischemic stroke than indirect bypass. However, there is still no clear evidence that revascularization surgery significantly prevents rebleeding in adult MMD patients. More significant angiographic changes were observed in direct and combined bypasses compared with indirect bypass.
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The necessity of red blood cell (RBC) transfusions in neurosurgical procedures is under debate. Although detailed recommendations exist for many other surgical disciplines, there are very limited data on the probability of transfusions during neurosurgical procedures. ⋯ The probability of blood transfusion during neurosurgical procedures is well below the 10 % level which is generally defined as the limit for preoperative appropriation of RBCs. Patients with spinal tumors, acute subdural hematomas or ICH, i.e., patients undergoing large decompressive procedures of bone or soft tissue, had a higher probability of transfusion.
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Acta neurochirurgica · Jul 2012
Case ReportsSurgical treatment of poorly visualised and complex cerebrovascular lesions using pre-operative angiographic data as angiographic DynaCT datasets for frameless stereotactic navigation.
Digital subtraction angiography (DSA) is the "gold standard" for the imaging of cerebrovascular lesions, particularly cerebral aneurysms and arteriovenous malformations (AVMs). Current stereotactic navigation is based on computed tomography (CT) and magnetic resonance (MR) images, which-even despite the use of CT angiographic (CTA) or MR angiographic (MRA) sequences-may not reveal small lesions, and may not demonstrate all the different facets of complex lesions. ⋯ Pre-operative formal cerebral angiography as an angiographic DynaCT dataset can be used safely and effectively for intra-operative navigation and treatment of cerebrovascular lesions, in particular, micro-cerebral AVMs.
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Acta neurochirurgica · Jul 2012
Types and severity of operated supraclavicular brachial plexus injuries caused by traffic accidents.
Brachial plexus injuries occur in up to 5% of polytrauma cases involving motorcycle accidents and in approximately 4% of severe winter sports injuries. One of the criteria for a successful operative therapy is the type of lesion. Upper plexus palsy has the best prognosis, whereas lower plexus palsy is surgically untreatable. The aim of this study was to evaluate a group of patients with brachial plexus injury caused by traffic accidents, categorize the injuries according to type of accident, and look for correlations between type of palsy (injury) and specific accidents. ⋯ Study results indicate that the most common injury was an upper plexus palsy. It was characteristic of bicycle accidents, and significantly more common in car and motorcycle accidents. The results also indicate that it is important to consider the potential of a brachial plexus injury after serious traffic accidents and to examine both upper extremities in detail even if some motor function is preserved.