Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Jan 2015
Case ReportsSurgical clipping of a basilar perforator artery aneurysm: a case of avoiding perforator sacrifice.
Aneurysms arising from basilar perforator arteries are very rare. A primary goal of surgery is always preservation of perforator flow. However, in most surgically managed cases in the literature, sacrifice of the perforator was reported. It is important for the literature to demonstrate that patency of the perforator is an achievable goal. ⋯ Although patency of the perforator is a rather obvious goal of cerebrovascular surgery, the current literature does not reflect an ability to do so in the case of basilar perforator aneurysms. We present only the second reported case of maintenance of perforator flow after clipping of a basilar perforator artery aneurysm.
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J Neurol Surg A Cent Eur Neurosurg · Jan 2015
Case ReportsThoracic spine localization using preoperative placement of fiducial markers and subsequent CT. A technical report.
A retrospective case series evaluating the use of fiducial markers with subsequent computed tomography (CT) or CT myelography for intraoperative localization. ⋯ Preoperative placement of fiducial markers confirmed with a CT or CT myelogram allows for reliable and fast intraoperative localization of the spinal level of interest with minimal risks and potential complications to the patient. In most cases, a noncontrast CT should be sufficient. This should be an equally reliable means of localization while further decreasing potential for complications. CT myelography should be reserved for pathology that is not evident on noncontrast CT. Accuracy of localization is independent of variations in rib number or vertebral segmentation. The technique is a safe, reliable, and rapid means of localizing spinal level during surgery.
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J Neurol Surg A Cent Eur Neurosurg · Jan 2015
Case ReportsPatient-controlled intracranial pressure for managing idiopathic intracranial hypertension.
Idiopathic intracranial hypertension is a difficult condition to manage. We present a novel treatment that substantially improved the headaches and reduced admissions and shunt revision surgery in a patient. We inserted a ventriculoperitoneal shunt, performed subtemporal craniectomies, and instructed our patient to apply different sized headbands to allow her to anticipate and control her own intracranial pressure: a tight headband for low-pressure headaches; no band for high-pressure headaches. Magnetic resonance imaging and intracranial pressure monitoring revealed this was not a placebo effect.
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J Neurol Surg A Cent Eur Neurosurg · Jan 2015
Case ReportsMinimally invasive direct lateral approach to the thoracolumbar junction: cadaveric analysis and case illustrations.
Multiple surgical exposures to the thoracolumbar junction have been described. The minimally invasive direct lateral approach to the lumbar spine captures the advantages of anterolateral approaches while minimizing soft tissue destruction and perioperative morbidity. Utilizing this approach at the thoracolumbar junction presents unique anatomical challenges posed by the ribs, diaphragm, pleura, and lung. ⋯ The minimally invasive direct lateral approach offers access to ventral pathology at the thoracolumbar junction. Familiarity with common anatomical structures encountered during this approach in the thoracolumbar junction enhances surgical planning and facilitates surgical exposure.
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J Neurol Surg A Cent Eur Neurosurg · Jan 2015
Indications and contraindications: interspinous process decompression devices in lumbar spine surgery.
Interspinous process decompression devices (IPD) allow a minimally invasive treatment of lumbar spinal stenosis (LSS), but their use is discussed highly controversial. Several level I studies suggest that IPD implantation is a viable alternative for both conservative treatment and decompression, but clear indications and contraindications are still missing. This study was designed to explore the perspectives and limitations of IPDs and to evaluate the role of these devices in general. ⋯ No clear consensus exists among spine surgeons concerning the use of IPD for LSS treatment. The study showed that hospital-related parameters also influence decision making for or against the use of IPDs. However, despite the lack of evidence, the indications and contraindications which had been identified in the present study might contribute to improved outcomes after IPD implantation or at least prevent harm to patients.