Acta neurochirurgica
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Acta neurochirurgica · Oct 2013
The sitting position in neurosurgery: indications, complications and results. a single institution experience of 600 cases.
The benefit of the sitting position for surgery of the posterior fossa and cervical spine is still a matter of controversy. In our study we analyzed the outcome after sitting position surgery at our institution. We compared the incidence of venous air embolism (VAE) as recognized with different monitoring techniques and the severity of complications. ⋯ In our series, VAE was detected in 19 % of all patients in the sitting position. However, in only 0.5 % of cases a termination of the surgical procedure became necessary. In all other cases, the cause of air embolism could be found and eliminated during surgery. TEE was found to be the monitoring technique with the highest sensitivity. In our opinion, the sitting position is a safe positioning technique if TEE monitoring is used.
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Acta neurochirurgica · Oct 2013
Comparative StudyComparison of early and late percutaneous endoscopic lumbar discectomy for lumbar disc herniation.
The optimal timing for percutaneous endoscopic lumbar discectomy (PELD) in cases of lumbar disc herniation (LDH) is debatable. This retrospective study sought to determine which category of PELD surgical intervention time resulted in greater improvement in clinical outcomes. ⋯ Early PELD surgical intervention did not result in greater improvement of clinical outcomes for patients with lumbar disc herniation. Later surgical intervention resulted in less failure rates for patients than the early surgical intervention groups. PELD performed when the leg pain before surgery being symptomatic for >6 months may be good for avoiding surgical failure and reducing the duration of leg pain.
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Acta neurochirurgica · Oct 2013
Lumbar total disc replacement: correlation of clinical outcome and radiological parameters.
The objective of this study was to correlate various radiological parameters with clinical outcome in patients who had undergone lumbar total disc replacement (TDR). Lumbar TDR is one possible treatment option in patients with low back pain (LBP), offering an alternative to lumbar fusion. Favourable clinical outcome hinges on a number of radiological parameters, such as mobility, sintering, and-most importantly-accurate positioning of the implant. ⋯ Our data indicate poor correlation between clinical outcome and position of the prosthesis. Although 48 % of the implants were suboptimally placed in either the coronal or sagittal plane, most of the patients reached a very good clinical outcome. However, suboptimally placed devices appeared to cause significantly more neurological symptoms in long-term follow-up.
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Acta neurochirurgica · Oct 2013
Comparative StudyAwake craniotomy may further improve neurological outcome of intraoperative MRI-guided brain tumor surgery.
Results of awake craniotomy are compared to results of resections done under general anesthesia in patients operated with IMRI control. We hypothesized that stimulation of the cortex and white matter during awake surgery supplements IMRI control allowing for safer resection of eloquent brain area tumors. ⋯ The study consisted of a limited patient series, but it implies that awake craniotomy with bipolar cortical stimulation may help to reduce the risk of postoperative impairment following resection of tumors located in or near speech and motor areas also under IMRI control.
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Acta neurochirurgica · Oct 2013
Facial nerve preservation with preoperative identification and intraoperative monitoring in large vestibular schwannoma surgery.
Microsurgery is an option of choice for large vestibular schwannomas (VSs). Anatomical and functional preservation of facial nerve (FN) is still a challenge in these surgeries. FNs are often displaced and morphologically changed by large VSs. Preoperative identification of FN with magnetic resonance (MR) diffusion tensor tracking (DTT) and intraoperative identification with facial electromyography (EMG) may be desirable for improving functional results of FN. ⋯ FN DTT is a powerful technique in preoperatively identification of FN in large VS cases. Continuous intraoperative FN EMG monitoring is contributive to locating and protecting FNs. Radical resection of large VSs as well as favorable postoperative FN outcome is available with application of these techniques.