Acta neurochirurgica
-
Acta neurochirurgica · Jul 2010
Case ReportsSynovial cyst that compressed the peroneal nerve: case report.
We report a case of synovial cyst that induced the compression of the peroneal nerve. The patient presented with foot drop and impossibility to stand on his right heel associated with numbness of anterolateral surfaces of the right shin and the dorsal surface of the foot within a 1-month period. Based on the clinical examination and electroneuromyography data, the compression of nerve by soft elastic mass was confirmed. ⋯ Histological study revealed the cyst of synovial membrane. During the postoperative period, a force in extensors of the right foot was restored. On the seventh day, the patient began to step on his right heel, while the zone of tenderness and temperature hypoesthesia in the area of the peroneal nerve innervation remained.
-
Acta neurochirurgica · Jul 2010
Surgical results and complications in a series of 71 consecutive cervical spondylotic corpectomies.
Cervical corpectomy is a common procedure in spondylosis. It is normally a well-tolerated surgery and clinical improvement is widely described. However, it is associated with potential risky complications (subsidence, clinical deterioration, vertebral artery injury...); thus, a judicious surgical indication and a good technique are required. ⋯ Cervical corpectomy is efficient for spinal cord decompression, especially when anterior components (disk osteophyte, OPLL...) bulge in the spinal cord. A three or more level corpectomy was not considered in this series since they may be associated to high rate morbidity. We found that this decompression led to better clinical results in patient grades 0 and 1 and to poorer results as myelopathy progressed. Among complications, subsidence was the most frequent specific one, but since it was rarely associated with symptoms, the majority of patients were successfully treated conservatively.
-
Acta neurochirurgica · Jul 2010
Historical ArticleClinical management of petroclival meningiomas and the eternal quest for preservation of quality of life: personal experiences over a period of 20 years.
Within the realm of neurosurgery, petroclival meningiomas are regarded as probably the most difficult tumour to be treated by microsurgery. This is due to the not infrequently large size of the tumours which, although predominantly located in the posterior fossa, may occupy more than one cranial compartment, with often significant space-occupying effect and brain stem compression. Frequent tight brain stem adherence as well as encasement of the basilar artery, its perforators and cranial nerves adds to the sometimes extreme difficulties of surgical tumour removal. Counselling patients as well as pre- and intraoperative decision making in petroclival meningiomas is even more difficult because upon clinical and radiological tumour detection, despite sometimes surprisingly large tumours, clinical symptoms are often only mild. Summarising the complicated development of petroclival meningioma surgery over the last 60 years, this paper represents the conceptual thinking of the author in regard to the treatment of petroclival meningiomas which has evolved over more than two decades, based on a special interest in these treacherous tumours, and accumulated experiences in the treatment of over 150 patients. Surgical concepts and the operative decision-making process are demonstrated in four illustrative cases. ⋯ Based on the experiences of the author, the following treatment principles in petroclival meningiomas are proposed: small tumours in asymptomatic patients should be observed. If tumour growth is detected on serial magnetic resonance imaging or treatment is desired by the patient, surgery should be the first choice. Radiosurgery in growing small tumours should be reserved to patients with advanced age or significant co-morbidities. In medium-sized tumours and symptomatic patients, radical surgery should be attempted, if possible by judicious intraoperative judgement. In large and giant petroclival meningiomas, tumour resection as radical as possible judged intraoperatively with decompression of neural structures should be performed, followed by observation and, in the case of growing tumour remnants, radiosurgery. Thus, by a combined application of advanced microsurgical techniques, thoughtful, intraoperative decision making with limited surgical aggressively and, in selected patients, with small tumours or small tumour remnants simple observation or alternative or adjunct radiosurgery, excellent results as measured by tumour control and preservation of quality of life can be achieved.
-
Acta neurochirurgica · Jun 2010
Flow replacement bypass for aneurysms: decision-making using intraoperative blood flow measurements.
There is much debate regarding the optimal strategy for extracranial-intracranial (EC-IC) bypass for complex aneurysms. We introduce the concept of a flow replacement bypass which aims to compensate for loss of flow in the efferent vessels of the aneurysm. The strategy to achieve this utilizes direct intraoperative flow measurements to guide optimal revascularization by matching graft flow to demand. ⋯ Direct intraoperative measurement of flow deficit in aneurysm surgery requiring parent vessel sacrifice can guide the choice of flow replacement graft and confirm the subsequent adequacy of bypass flow.
-
Acta neurochirurgica · Jun 2010
Transcranial color-coded duplex sonography allows to assess cerebral perfusion pressure noninvasively following severe traumatic brain injury.
Assess optimal equation to noninvasively estimate intracranial pressure (eICP) and cerebral perfusion pressure (eCPP) following severe traumatic brain injury (TBI) using transcranial color-coded duplex sonography (TCCDS). ⋯ TCCDS-based equation (ICP = 10.927 x PI - 1.284) allows to screen patients at risk of increased ICP and decreased CPP. However, adequate therapeutic interventions need to be based on continuously determined ICP and CPP values.