Acta neurochirurgica
-
The transcallosal approach provides a direct corridor to the lesions lying in the third ventricle with distinct advantages over alternative routes, such as the possibility to use multiple corridors for tumor resection. ⋯ This approach requires the ability to move around many neurovascular, cortical, and white matter structures. Knowledge of regional anatomy and adherence to principles of microsurgery are basic requirements to obtain a favorable outcome.
-
Acta neurochirurgica · Jun 2013
Image-guided resection of spheno-orbital skull-base meningiomas with predominant intraosseous component.
Although meningiomas of the spheno-orbital region commonly result in hyperostosis, intraosseous meningiomas, which feature extensive full thickness infiltration of the anterolateral skull base, are rare. In this study, we assess the value of image guidance during surgery for intraosseous spheno-orbital skull-base meningiomas in achieving safe and maximal abnormal bone resection. ⋯ Intra-operative image guidance allowed total or near-total resection of the hyperostotic skull base around the cranial nerve foramina with minimal morbidity in a group of patients with extensive spheno-orbital meningiomas.
-
Acta neurochirurgica · Jun 2013
Emotional health and quality of life after aneurysmal subarachnoid hemorrhage.
Emotional disorders and decrease in health-related quality of life (HRQoL) are well-documented sequelae of aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to analyze the impact of emotional disorders on HRQoL in survivors of SAH. ⋯ Emotional disorders are frequent after SAH and significantly associated with impairment of HRQOL. Proper and timely screening tests are important to reveal development of emotional problems and improve QoL for the SAH-patients.
-
Acta neurochirurgica · Jun 2013
How I do it : anterior clinoidectomy and optic canal unroofing for microneurosurgical management of ophthalmic segment aneurysms.
Power drilling commonly used for anterior clinoidectomy and optic canal unroofing can result in thermal injury to the optic nerve. ⋯ • Anterior clinoidectomy and optic canal unroofing is an important skull base technique required for safe clipping of the majority of ophthalmic segment aneurysms • Power drilling commonly used for optic canal unroofing can cause thermal injury to optic nerve • More than 2 mm free space is available around the optic nerve in the optic canal • Foot plate of 1 mm Kerrison punch can be safely introduced within a normal optic canal without causing mechanical injury to the optic nerve • Reflection of posteriorly based dural flap acts as a dural barrier, preventing direct contact of drill bit to optic nerve, internal carotid artery and aneurysm during drilling • Entanglement of cottonoids to rotating drill bit is a major problem in intradural anterior clinoidectomy • Wet gelfoam pieces do not get entangled to the rotating drill bit • Structures surrounding the area of drilling can be covered with wet gel foam pieces to prevent direct contact of the drill to neurovascular structures • Opened cisterns can be covered with wet gelfoam pieces during drilling to prevent deposition of bone dust in the subarachnoid space • "Limited drill technique" of anterior clinoidectomy and optic canal unroofing is a safe and effective technique for the exposure of ophthalmic segment aneurysms.