Journal of neurological surgery. Part A, Central European neurosurgery
-
J Neurol Surg A Cent Eur Neurosurg · Sep 2015
Evaluation of Occipitocervical Arthrodesis Rates with Screw-based Fixation and Osteoinductive Fusion Adjuncts.
Occipitocervical (OC) instability may be associated with neurologic impairment and even death. There is a paucity of research on the rate of arthrodesis utilizing modern screw-based constructs coupled with adjuvant osteoinductive agents. We reviewed our experience with OC constructs and compared the fusion rate, functional outcome, and rate of adverse events between recombinant human bone morphogenetic protein (BMP)-2, autologous iliac crest bone graft (ICBG), a combination of BMP and ICBG, and local bone autograft alone. ⋯ Additionally, perioperative adverse events occurred in 23% of cases and did not vary significantly in incidence or severity between fusion adjunct cohorts. We present a large series of patients treated for OC instability with rigid fixation utilizing modern segmental screw-based constructs. The use of adjuvant osteoinductive agents (BMP, ICBG, or a combination) produced equivalent rates of arthrodesis, functional outcome, and adverse events compared with use of local autograft alone.
-
J Neurol Surg A Cent Eur Neurosurg · Sep 2015
Spinal Extradural Arachnoid Cysts: A Series of 10 Cases.
Spinal arachnoid cysts are rare lesions, accounting for only 1% of all primary spinal mass lesions. They can occur in extradural, intradural, or intramedullary locations. The extradural cysts are thought to arise from defects in the dura mater through which the arachnoid herniates. This report presents 10 cases of spinal extradural arachnoid cysts and discusses our diagnostic and therapeutic approach to this rare clinical entity. ⋯ Spinal extradural arachnoid cysts are rare pathologies, and treatment options should be considered carefully. In symptomatic cases, total excision of the cyst should be considered the gold standard of treatment. We believe that the closure of the dural defect should be the main surgical goal to prevent recurrence. We propose laminoplasty for the treatment of extradural arachnoid cysts that involve multiple segments to prevent postoperative kyphosis.
-
J Neurol Surg A Cent Eur Neurosurg · Sep 2015
Endoscope-assisted Transorbital Keyhole Surgical Approach to Ruptured Supratentorial Aneurysms.
Many different surgical approaches have been described to treat intracranial aneurysms. A common feature of all the approaches has been relatively extensive brain exposure and brain retraction with increasing surgical morbidity. Transorbital keyhole is one of the minimally invasive approaches. Endoscope-assisted transorbital keyhole surgery (EATOKS) combines minimally invasive transorbital keyhole surgery with endoscope-assisted microneurosurgery. We describe our experience with this approach and its efficacy in treating ruptured supratentorial aneurysms. ⋯ EATOKS is a viable and safe option in the neurosurgical armamentarium to treat ruptured supratentorial aneurysms.
-
J Neurol Surg A Cent Eur Neurosurg · Jul 2015
The Impact of a Standardized Sodium Protocol on Incidence and Outcome of Dysnatremias in Neurocritical Care.
Dysnatremias are common and prognostically serious in neurocritical care. We studied whether a standardized sodium protocol would improve our neurocritical care of dysnatremias. ⋯ The standard sodium protocol lowered the frequency of SIADH, which was encountered in only one patient over 5 years. However, it did not significantly reduce the incidence and improve the outcome of hyponatremia. Hypernatremia occurred more often and had a higher mortality and worse outcome than hyponatremia, but these patients were neurologically worse upon its onset. The prospective study confirmed that CSW, SIADH, and CDI were not common in our neurocritical care.
-
J Neurol Surg A Cent Eur Neurosurg · Jul 2015
Case ReportsMicrosurgical and Endoscopic Posterior Transcortical Keyhole Approach to the Atrium of the Lateral Ventricle: A Cadaveric Study.
Accessing large lesions located in the atrium of the lateral ventricle without causing a neurologic deficit can be challenging. The aim of this study was to evaluate a modification of the posterior transcortical approach that may create sufficient exposure to the atrium of the lateral ventricle with less injury to the brain cortex and fibers using a technique that combines a microscope with an endoscope. ⋯ The microsurgical posterior transcortical keyhole approach could provide an ideal exposure to the atrium and the posterior part of the body of the lateral ventricle. The endoscopic posterior transcortical keyhole approach demonstrated a wider viewing range compared with the microscope. An endoscopic-controlled or -assisted surgery may reduce damage to normal brain tissue, facilitate total resection of the lesion, and improve the surgical outcome.