Acta neurochirurgica
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Acta neurochirurgica · Feb 2020
Synergetic efficacy of simultaneous DRG- and traditional spinal cord stimulation.
Dorsal root ganglion stimulation has established its role in chronic pain states and is commonly used as an alternative treatment to traditional spinal cord stimulation. Due to its approach, DRG stimulation is preferably used in pain conditions affecting a small area or a distinct nerve root. In selected patients, a combination of both techniques might be useful. ⋯ The combination of dorsal root ganglion and traditional spinal cord stimulation is surgically and technically feasible. In selected patients, the combination of both methods offers an option to alleviate pain states not sufficiently or not efficiently treated with one method alone. The introduction of IPGs combining SCS and DRG stimulation paradigms might be useful to increase acceptance of this option.
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Acta neurochirurgica · Jan 2020
Contralateral cervical seventh nerve transfer for spastic arm paralysis via a modified prespinal route: a cadaveric study.
We proposed contralateral cervical seventh nerve transfer for spastic arm paralysis after central neurological injury in the New England Journal of Medicine (NEJM) in 2018. In this surgery, we applied a new surgical route for nerve transfer, the Huashan prespinal route. The objective of this study was to elaborate our new surgical technique, clarify its relationship to the vertebral artery, and provide anatomical data on this novel method. ⋯ The cadaveric study confirms that the presented technique allowed simple, effective, and safe contralateral C7 nerve transfer. This technique can be used in the treatment of hemiplegia and brachial plexus injury. There is a safe scope of drilling angle for creating the longus colli muscle tunnel required for this surgical route. The anatomical parameters obtained in this study will be helpful for the performance of this operation.
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Acta neurochirurgica · Jan 2020
Comparative StudyFlow-regulated versus differential pressure valves for idiopathic normal pressure hydrocephalus: comparison of overdrainage rates and neurological outcome.
To compare flow-regulated (FR) and differential pressure (DP) valves for treatment of patients with idiopathic normal hydrocephalus (iNPH) focusing on overdrainage and neurological outcome. ⋯ The current study demonstrates a comparable neurological improvement between DP and FR valves, with potentially lower overdrainage rates among FR valves. Long-term studies will be necessary to draw a definite conclusion on FR valves for treatment of iNPH patients.
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Acta neurochirurgica · Oct 2019
Gradual expansion of stent retriever in mechanical thrombectomy for curved middle cerebral artery: structural findings of the stent for predictable recanalization results.
Trevo Provue stent retriever with visible struts under fluoroscopy may be useful in identifying the optimal position and expansion of the stent during the procedure. This study aimed to demonstrate and analyze changes in the segmental diameter of a radio-opaque stent retriever after deployment according to recanalization results, and its relationship with the angle of the occluded segment of the middle cerebral artery (MCA). ⋯ The diameter of the stent retriever after deployment was associated with the recanalization results in mechanical thrombectomy following MCA occlusion.
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Acta neurochirurgica · Oct 2019
How I do it: total uncinatectomy during anterior diskectomy and fusion for cervical radiculopathy caused by uncovertebral joint hypertrophy.
Cervical radiculopathy from uncovertebral joint hypertrophy and foraminal stenosis is a common indication for anterior cervical diskectomy and fusion (ACDF). Often, the uncinate hypertrophy extends lateral to the foramen and impinges on the nerve close to the vertebral artery as it travels in between the transverse foramina. ⋯ Total uncinatectomy is a useful adjunct during ACDF for complete foraminal decompression in cases of uncovertebral joint hypertrophy.