Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
ReviewManagement of arteriovenous malformations related to Spetzler-Martin grading system.
Advanced technology and improved understanding of the natural history of arteriovenous malformations (AVMs) led to the reconsideration of the management of these lesions, which once comprised purely microsurgical removal. A multidisciplinary approach for both the evaluation and treatment of AVMs has gained acceptance within the past few decades. ⋯ The risk of a chosen management strategy must include the sum of the risk of all the interventions applied to a given lesion, and this should be compared with the natural history of a given lesion in a particular clinical setting. Among all components of the multimodality treatment, however, microsurgical removal remains the definitive form of treatment.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
Comparative StudyTranscranial microsurgical and endoscopic endonasal cavernous sinus (CS) anatomy: a cadaveric study.
Even in the era of tremendous microneurosurgical and endoscopic development, the cavernous sinus (CS) is a challenging anatomical site for a neurosurgeon. Many transcranial and a few endoscopic cadaveric studies have been done to study the CS; probably none were undertaken to study its microsurgical and endoscopic anatomy side by side. In this cadaveric study we perform a side-by-side comparison of the microsurgical and endoscopic anatomy of the CS that can help neurosurgeons deal with CS lesions more efficiently. ⋯ Microscopic and endoscopic exposure of the CS is relatively easy in cadavers. But endoscopic or microsurgical exposure of the CS during surgery is more difficult requiring skill. With experience of the cadaveric study , the CS may be explored via transcranial microsurgery, endonasal endoscopy, or both simultaneously, according to the nature and extension of the pathology.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
Case ReportsAvoidance of electrode related MRI artifact during staged deep brain stimulator implantation.
Centers implanting deep brain stimulator (DBS) electrodes on different days often protect the first electrode tip with a protective cap, tunnel it under the scalp, and connect it to the generator at a later procedure. If magnetic resonance imaging (MRI) is used for planning during the second implantation, MRI artifacts from the protective cap could potentially corrupt the stereotactic coordinates. The importance of this problem may increase if emerging MRI safety data lead to more frequent use of MRI for these purposes. ⋯ A silastic sleeve provides adequate protection of the DBS electrode during staged implantation and avoids the MRI artifact associated with protective caps with screws.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
CSF fistulas after transsphenoidal pituitary surgery--a solved problem?
Transsphenoidal surgery has been the gold standard for intra- and suprasellar lesions as well as some extrasellar pathologies for more than 40 years. This approach, with proper surgical expertise, is very safe with a low morbidity and mortality rate. However, as with every surgical treatment, complications can occur and may result in serious consequences for the patient. The goal of this article is to focus on cerebrospinal fluid (CSF) fistulas after transsphenoidal surgery and discuss possible risk factors and treatment options, including less common procedures in persistent CSF fistulas. ⋯ CSF fistulas continue to present a problem after transsphenoidal surgery and require sophisticated technical measures to treat this complication. Failure after repair can occur and necessitates more intense treatment modalities. The usage of the transsphenoidal approach in other skull base lesions leads to higher rates of CSF fistulas and subsequently higher frequency of meningitis.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
Effects of acute intracranial hypertension on extracerebral organs: a randomized experimental study in pigs.
The study was conducted to determine the effects of isolated acute intracranial hypertension (AICH) on extracerebral organs. ⋯ Isolated AICH induces injury to multiple extracerebral organs, even in the absence of hypoperfusion or hypoxemia.