Acta neurochirurgica
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Acta neurochirurgica · Nov 2002
Atlantoaxial screw fixation for the treatment of isolated and combined unstable jefferson fractures - experiences with 8 patients.
The unstable atlas burst fracture ("Jefferson fracture") is a fracture of the anterior and posterior atlantal arch with rupture of the transverse atlantal ligament and an incongruence of the atlanto-occipital and the atlanto-axial joint facets. The question whether it has to be treated surgically or nonsurgically is still discussed and remains controversial. During the last decade 8 patients with unstable atlas burst fractures were examined and treated in our department. ⋯ Nonsurgical treatment with halo extension always bears the risk of insufficient healing with further instability and a fixated incongruence of the atlanto-occipital and the atlanto-axial joints, leading to arthrosis, immobility and increasing neck pain. After 10 weeks of insufficient immobilization secondary pre- and intra-operative reposition manoeuvres and surgical fixation hardly can reverse this fixated incongruence. Moreover, halo-extension needs an immobilization of the cervical spine for about 10 weeks and more, which is very uncomfortable and leads to further complications especially in elderly patients.
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Acta neurochirurgica · Nov 2002
Congenital reducible atlantoaxial dislocation: classification and surgical considerations.
Reducible atlanto-axial dislocation (AAD) may cause severe motor and respiratory compromise due to recurrent spinal cord and/or brain stem impingement. To the best of the authors' knowledge, this is the first study concentrating on the classification, the protocol of the surgical management and the outcome of congenital, reducible AAD. ⋯ The patients with congenital reducible AAD, depending on their surgical management, may be classified into four groups. Some patients with a dysplastic odontoid have a "hypermobile" AAD and require special care during intubation, positioning and stabilization. An assimilated posterior arch is often associated with asymmetrical lateral occipito-C1-C2 joint synostosis rendering transarticular screw placement difficult. The various causes of failure of constructs are discussed.
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Acta neurochirurgica · Nov 2002
Serial transcranial Doppler measurements in traumatic brain injury with special focus on the early posttraumatic period.
Cerebral ischemia is considered a key factor in the development of secondary damage after Traumatic Brain Injury (TBI). Studies on Cerebral Blood Flow (CBF) have documented decreased flow in over 50% of patients with TBI, studied in the acute phase. Transcranial Doppler (TCD) sonography is a non-invasive technique, permitting frequent or continuous measurements of blood flow velocity in the basal cerebral arteries. ⋯ TCD studies show reduction of cerebral blood flow velocity in the acute phase after traumatic brain injury. Decreased flow velocity is most pronounced ipsilateral to focal pathology. A low flow velocity state is probably due to high peripheral resistance, and is indicative of ischemia, as demonstrated by the association with decreased PbrO(2). A low flow velocity state is of prognostic value and identifies patients at increased risk for ischemia. Early TCD studies are recommended in TBI.
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Acta neurochirurgica · Oct 2002
Magnetic resonance imaging-based morphometry and landmark correlation of basal ganglia nuclei.
The two principle targets for deep brain stimulation or lesioning in patients with Parkinson's disease, the subthalamic nucleus (STN) and the globus pallidus internus (GPi), reveal a high degree of individual variability which is relevant to the planning of stereotactic operations. Both nuclei can clearly be delineated in T2WI spin echo MRI which was acquired under stereotactic conditions in general anesthesia before surgery. Such images of 35 patients served for retrospective morphometric analysis of different basal ganglia nuclei (STN, GP, red nucleus, and substantia nigra) and several anatomical landmarks (anterior and posterior commissure, maximum width of third ventricle, brain length and width). ⋯ The STN and GP was located farther lateral in males which may be due to overall brain anatomy as gender-specific differences were also observed for brain width and length and AC-PC distance. MRI-based in vivo-localization of different basal ganglia nuclei extend statistical information from common histological brain atlases which are based on a limited number of brains. The correlations observed between different basal ganglia nuclei, i.e. the STN and GPi, and anatomical landmarks may be useful for surgical planning.
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Acta neurochirurgica · Oct 2002
Review Comparative StudyCranio-cervical decompression for Chiari type I-malformation, adding extreme lateral foramen magnum opening and expansile duroplasty with arachnoid preservation. Technique and long-term functional results in 44 consecutive adult cases -- comparison with literature data.
Posterior cranio-cervical decompression by opening at least foramen magnum and C1-lamina usually with corresponding dural and arachnoid opening, is the procedure most currently used for treating Chiari I malformation (alone or in association with syringomyelia). To optimize decompressive effects together with reducing risks, a procedure was developed which consists of a sub-occipital craniectomy and a C1 (or C1/C2) laminectomy, plus an extreme lateral Foramen Magnum opening, a "Y" shaped dural incision with preservation of the arachnoid membrane, and an expansile duroplasty employing autogenous periosteum. The purpose of the article is:1. to report the long-term functional results in a consecutive series of 44 adult patients affected by symptomatic Chiari Malformation type I (CM) using the procedure described.2. and to compare this technical modality with the other modalities reported in the literature. ⋯ The presented technique was compared with the other surgical modalities reported in the literature. This comparative study shows that cranio-cervical decompression with extreme lateral resection of the posterior rim of Foramen Magnum out to the level of the occipital condyles on either side, associated with an enlargement duroplasty with preservation of the arachnoid membrane, achieved the best results with minimal complications and side-effects.