Acta neurochirurgica
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Acta neurochirurgica · Jun 2014
Selection of surgical approaches based on semi-quantifying the skull-base invasion by petroclival meningiomas: a review of 66 cases.
Petroclival meningiomas are still challenging for neurosurgeons. In the present study, we reviewed 66 petroclival meningiomas that underwent craniotomy to assess the surgical approaches for petroclival meningiomas based on semi-quantifying tumor extension to skull base and to evaluate the outcomes. ⋯ We introduced a simple and practicable method for classification of petroclival meningiomas, which could semi-quantify tumor invasion and help to select surgical approaches. With careful preoperative evaluation, a cautiously selected approach would improve the prognosis.
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Acta neurochirurgica · Jun 2014
A retrospective study of 113 consecutive cases of surgically treated spondylodiscitis patients. A single-center experience.
Recommendations for the operative treatment of spondylodiscitis are still a controversial issue. ⋯ The results of our retrospective study show that surgical treatment of spondylodiscitis with a staged surgical approach (if needed) and a short 1-2-week period of intravenous antibiotics followed by 3 months of oral antibiotics is appropriate for most patients in whom conservative treatment has failed or is not advisable. Furthermore, surgical treatment of newly diagnosed spondylodiscitis might be recommended as an initial treatment option in many cases. Thereby the choice of fusion material (autologous bone, titanium, PEEK) seems less important.
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Acta neurochirurgica · Jun 2014
The strategy of microvascular decompression for hemifacial spasm: how to decide the endpoint of an MVD surgery.
Microvascular decompression (MVD) has become the standard treatment for hemifacial spasm. As not all patients get complete relief, this strategy is still controversial. The study aimed to figure out how to tell the proper endpoint to the surgery. ⋯ MVD operations can be ended only after the full-length evidence, vascular evidence and electrophysiological evidence are all present.
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Acta neurochirurgica · Jun 2014
Combined intraoperative monitoring of abnormal muscle response and Z-L response for hemifacial spasm with tandem compression type.
Multiple neurovascular compression is present in about 38 % cases of hemifacial spasm (HFS). In these cases, the vertebral artery (VA) compresses another vessel, which in turn compresses the nerve. This type was named as "the tandem type". In the tandem type, the real offending vessel is often concealed by the VA. It is sometimes neglected by the surgeons. In this study, we report our experience in using abnormal muscle response (AMR) and ZL-Response (ZLR) simultaneously as intraoperative monitoring for MVD surgery of HFS with "the tandem type" vascular compression involving VA. ⋯ The combination of AMR and ZLR provides more useful information than does the AMR alone, and ZLR may be the only useful intraoperative monitoring for MVD surgery in times when AMR is absent or persists. ZLR played a crucial role in finding the real offending vessel, which was often concealed by the VA in tandem type.
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Acta neurochirurgica · May 2014
Mini-craniotomy as the primary surgical intervention for the treatment of chronic subdural hematoma--a retrospective analysis.
The incidence of chronic subdural hematoma (CSDH) is increasing, but optimal treatment remains controversial. Recent meta-analyses suggest burr hole (BH) drainage is the best treatment because it provides optimal balance between recurrence and morbidity. Mini-craniotomy may offer supplementary technical advantages while maintaining equal or better outcomes. This study investigates the outcome of mini-craniotomy as the sole treatment in patients with CSDH. ⋯ This is the first published series of CSDH in which all consecutive patients were operated on by mini-craniotomy. The invasiveness and complication rate of mini-craniotomy are equal to those of burr hole treatment, but visualization is superior, resulting in lower recurrences. A randomized controlled trial is indicated to identify the best surgical strategy for the treatment of CSDH.