Acta neurochirurgica
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Acta neurochirurgica · Aug 2016
Endoscopic endonasal resection of ACTH secreting pituitary microadenoma; how I do it.
Transsphenoidal selective adenectomy is considered the treatment of choice in patients with Cushing's disease given the possibility for high remission and low complication rates. The endoscopic endonasal surgical nuances for Cushing's disease are not well illustrated in the neurosurgical technique and video collections. ⋯ Transsphenoidal endoscopic selective adenectomy is a safe and effective surgery for patients with Cushing's disease regardless of preoperative MRI findings.
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Acta neurochirurgica · Jul 2016
Clinical outcomes during the learning curve of MIDline Lumbar Fusion (MIDLF®) using the cortical bone trajectory.
The objective of this study is to review the clinical outcomes of a novel minimally invasive surgery (MIS) technique for the treatment of instability of the lumbar spine using the cortical bone trajectory (CBT). We present a prospective review of the clinical outcomes from the first 25 consecutive cases in a single unit during the initial learning phase. ⋯ Our results indicate that lumbar instrumentation using CBT is safe and effective with comparable results to those published for posterior lumbar interbody fusion (PLIF) even with the learning curve of new procedures. Patients who underwent a MIDLF® needed a shorter operative time, and they were mobilized and discharged quicker, with figures almost similar to those from non-instrumented surgery. While in this case series the preoperative ODI and back pain VAS significantly predicted the post-operative variable, the same could not be demonstrated for leg pain, preoperative walking distance, number of pain killers, or the patient BMI. Larger studies with longer follow-up are needed in order to better understand and assess the possible advantages of this technique.
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Acta neurochirurgica · Jul 2016
Benefits of microvascular decompression on social anxiety disorder and health-related quality of life in patients with hemifacial spasm.
Hemifacial spasm (HFS), an involuntary movement disorder characterized by unilateral spasms of the muscles innervated by the facial nerve, is likely to cause social anxiety disorder due to its significant facial disfigurement and may have a significant influence on a patient's health-related quality of life (HRQoL). The goal of this study was to investigate the influence of microvascular decompression (MVD) on the severity of social anxiety symptoms and HRQoL in patients with HFS. ⋯ This study shows that HFS patients seem to gain benefits from MVD not only for their facial disfigurement but also for social anxiety symptoms that may be associated with mental health improvements in their quality of life.
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Acta neurochirurgica · Jul 2016
Patient and aneurysm characteristics associated with rupture risk of multiple intracranial aneurysms in the anterior circulation system.
Multiple intracranial aneurysms (MIAs) are associated with poorer outcomes after rupture than are single intracranial aneurysms (SIAs). Although the risk factors for intracranial aneurysm rupture have been widely investigated, few studies have focused on MIAs. Thus, the present study aimed to determine whether there are differences in the patient and aneurysm characteristics between those with ruptured and unruptured anterior circulation MIAs (AC-MIAs). ⋯ The present study found that current smokers who smoked more than 20 cigarettes per day and those with hypertension but an irregular use of anti-hypertensive medications were more likely to suffer from rupture. Aneurysm location and bleb formation were closely related to the rupture of AC-MIAs, and SR was a better predictor of AC-MIAs rupture status than size, neck width, BNF, H/W and AR. These findings should be verified by future prospective follow-up studies of AC-MIAs.
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Acta neurochirurgica · Jul 2016
Endoscopic endonasal anatomy of the ophthalmic artery in the optic canal.
The endoscopic endonasal opening of the optic canal has been recently proposed for tumors with medial invasion of this canal, such as tuberculum sellae meningiomas. Injury of the ophthalmic artery represents a dramatic risk during this maneuver. Therefore, the aim of this study was to analyze the endoscopic endonasal anatomy of the precanalicular and canalicular portion of this vessel, discussing its clinical implication. ⋯ The endoscopic endonasal approach gives a direct, extensive and panoramic view of the course of the precanalicular and canalicular portion of the ophthalmic artery. Dedicated high-field neuroimaging studies are of paramount importance in preoperative planning to evaluate the anatomy of the ophthalmic artery, reducing the risk of jeopardizing the vessel, particularly for those uncommon cases with an infero-medial course of the artery.