Acta neurochirurgica
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Acta neurochirurgica · Oct 2013
The preoperative use of navigated transcranial magnetic stimulation facilitates early resection of suspected low-grade gliomas in the motor cortex.
Resection is recommended for low-grade gliomas, but often it is not performed if the tumor is suspected of invading the primary motor cortex. The study aim is to assess what influence preoperative navigated transcranial magnetic stimulation (nTMS) has on the treatment strategy and clinical outcome for suspected low-grade gliomas in presumed motor eloquent location. ⋯ nTMS provides accurate motor mapping results also in infiltrative gliomas and enables more frequent and more extensive surgical resection of non-enhancing gliomas in or near the primary motor cortex. The substantial differences observed here in neurological and oncological outcomes suggest that further comparative research is warranted.
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Acta neurochirurgica · Oct 2013
Anatomical variation of superior petrosal vein and its management during surgery for cerebellopontine angle meningiomas.
No systematic study is yet available that focuses on the surgical anatomy of the superior petrosal vein and its significance during surgery for cerebellopontine angle meningiomas. The aim of the present study was to examine the variation of the superior petrosal vein via the retrosigmoid suboccipital approach in relation to the tumor attachment of cerebellopontine angle meningiomas as well as postoperative complications related to venous occlusion. Forty-three patients with cerebellopontine angle meningiomas were analyzed retrospectively. ⋯ Intraoperative sacrificing of veins was associated with a significantly higher rate of venous-related phenomena, while venous complications occurred even in cases where the superior petrosal vein was absent or compressed by the tumor. The variation in the superior petrosal vein appeared to differ among the tumor attachment subtypes, which could permit a satisfactory surgical exposure without dividing the superior petrosal vein. In cases where the superior petrosal vein was previously occluded, other bridging veins could correspond with implications for the crucial venous drainage system, and should thus be identified and protected whenever possible.
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Acta neurochirurgica · Oct 2013
Suboccipital endoscopic management of the entrapped fourth ventricle: technical note.
Entrapped fourth ventricle is the result of both inlet aqueduct and outlet fourth ventricular midline and lateral foraminae obstruction. It occurs as a sequalae of intracranial hemorrhagic or inflammatory disease condition. Usually it presents after previous shunting for communicating hydrocephalus with a period of improvement, after which manifestations of posterior fossa expanding process appear. The diagnosis of this rare condition is easy considering the patient past history and the recent clinical state, together with the midline CSF density of the dilated fourth ventricle in either the CT or MR images. The treatment options for this condition include open and endoscopic approaches together with the traditional ventricular to extracranial CSF diversionary procedures. ⋯ Endoscopic suboccipital paramedian aqueductoplasty with the use of a stent is a safe and effective surgical option that-in our opinion-should stand as the first line treatment for the entrapped fourth ventricle. Long stent is better used after aqueductoplasty to avoid the restenosis if no stent is used or stent fall after short stents. However, good case selection, familiarity with this fairly common endoscopic approach and longer follow-up is needed for obtaining an optimal result.
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Acta neurochirurgica · Oct 2013
A surgical technique to expand the operative corridor for supracerebellar infratentorial approaches: technical note.
The supracerebellar infratentorial approach is a commonly used route in neurosurgery. It provides a narrow and deep corridor to the dorsal midbrain and pineal region. The authors describe a surgical technique to expand the operative corridor and the surgeon's working angles during this approach. ⋯ The use of stay sutures anchored on the tentorium is a simple and effective technique that expands the surgical corridor during supracerebellar infratentorial approaches.
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Acta neurochirurgica · Sep 2013
Biography Historical ArticleVon Bergmann, Kocher, and Krönlein--a triumvirate of pioneers with a common neurosurgical concept.
The rise of a neurosurgical subspecialisation in general surgery was strongly influenced by some key surgeons. In the German-speaking regions of Europe, Ernst von Bergmann, Emil Theodor Kocher and Rudolf Ulrich Krönlein have to be especially highlighted. ⋯ This triumvirate developed a common neurosurgical concept that was grounded in the physiological experiments and scientific evidence.