Acta neurochirurgica
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Acta neurochirurgica · May 2011
Bilateral subthalamic deep brain stimulation using single track microelectrode recording.
Microelectrode recording (MER) is widely used during deep brain stimulation (DBS) procedures because MER can identify structural borders and eloquent structures, localize somatotopic arrangements, and provide an outline of the three-dimensional shapes of target nuclei. However, MER may cause intracranial hemorrhage. We preformed single track MER during DBS procedures, analyzed the accuracy of electrode positioning with MRI, and compared the amount of air and the potential risk of intracranial hemorrhage. ⋯ Although MER can facilitate accurate positioning of electrodes, multi-track MER may increase the risk of intracranial hemorrhage. The accuracy of electrode positioning appears to be acceptable under single track MER during STN DBS with careful electrophysiological and neurological monitoring. The risk of intracranial hemorrhage appears to be minimal, especially in elderly patients with atrophic brains.
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Acta neurochirurgica · May 2011
Bilateral open-door expansive laminoplasty using unilateral posterior midline approach with preservation of posterior supporting elements for management of cervical myelopathy and radiculomyelopathy--analysis of clinical and radiological outcome and surgical technique.
The purpose of this study was to evaluate bilateral open-door cervical laminoplasty for management of cervical canal stenosis secondary to multisegmental cervical spondylosis and ossified posterior longitudinal ligament. The importance of unilateral posterior approach with preservation of posterior supporting element is emphasized. ⋯ Bilateral open-door expansive laminoplasty using unilateral posterior midline approach provides preservation of posterior supporting tension band and excellent reconstruction of spinal canal. This technique also does not compromise contralateral paraspinal muscles attached to spinous process.
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Acta neurochirurgica · May 2011
Cryoneurolysis for zygapophyseal joint pain: a retrospective analysis of 117 interventions.
Lumbar facet joint syndrome (LFJS) is the cause of pain in 15-54% of the patients with low-back pain. There are few studies of cryotherapy for LFJS, focusing mainly on pain scores rather than further outcome measures. The aim of the study was to determine the long-term outcome after cryoneurolysis of lumbar facet joints, looking at pain scores, pain-related impairment patient satisfaction, and pain-related anxiety/depression. ⋯ Cryoneurolysis for LFJS can lead to favourable results with sustained pain relief, amelioration of pain-related disability and reduction of depression scores.
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Acta neurochirurgica · May 2011
Comparative StudyThe impact of subdural air collection on intraoperative motor and somatosensory evoked potentials: fact or myth?
Surgery in the semi-sitting position is susceptible to changes in motor (MEP) and somatosensory evoked potentials (SEPs), which are not related to neurological impairment. These changes have been suggested to be caused by the insulating effect of subdural air collection. This study sought to investigate the correlation of MEP and SEP final-to-baseline amplitude ratios to postoperative volumetry of frontoparietal subdural air collection. ⋯ Although SEP amplitude reductions were associated with large subdural air collections, this was not observed in the subset of patients with SEP attenuation and for the MEP monitoring, suggesting other pathophysiological mechanisms, such as brain shift, for the artificial amplitude reduction.
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Acta neurochirurgica · May 2011
Use of twist-drill craniostomy with drain in evacuation of chronic subdural hematomas: independent predictors of recurrence.
Recurrence rates after chronic subdural hematoma (CSDH) evacuation with any of actual techniques [twist-drill craniostomy (TDC), burr-hole craniostomy, craniotomy] range from 5% to 30%. Use of drain has improved recurrence rates when used with burr-hole craniostomy. Now, we analyze predictors of recurrence of TDC with drain. ⋯ TDC with drain has similar results in recurrence rates, morbidity, mortality, and outcome as other techniques as burr-hole craniostomy with drain. Preoperative and postoperative hematoma width and midline shift are independent predictors of recurrence. Brain re-expansion and time of drain maintenance are important factors related with recurrence of CSDH. Future CSDH reservoirs must avoid negative pressure and sudden pressure changes inside the whole closed drain system.