Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Sep 2015
Catheter-Based Trans-Epidural Approach to Aspirate Cervical and Thoracic Epidural Abscesses: A Cadaveric Feasibility Study.
Approaching and aspirating cervical and high thoracic epidural abscesses through a trans-epidural route from the lumbar region access represents an alternative method for selected patients. ⋯ Our observations support the further exploration of a percutaneous catheter-based trans-epidural approach to treat epidural abscesses. The trans-epidural approach may be used alone or as a staged or concurrent approach with open surgical treatment.
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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.
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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.
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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.
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J Neurol Surg A Cent Eur Neurosurg · Jul 2015
The Fate of Type II Odontoid Fractures after Posterior Atlantoaxial Fusion: Where Does Healing Occur?
Anderson and D'Alonzo type II odontoid fractures often require surgical intervention. Our goal was to understand the pattern of healing in patients who had a posterior atlantoaxial fusion for a type II odontoid fracture. ⋯ There is a high rate of fusion across the fracture site of a type II odontoid fracture after posterior atlantoaxial fixation. In young patients with acute type II fractures who are not candidates for anterior screw fixation, posterior atlantoaxial instrumentation without fusion may be sufficient for fracture healing, thus allowing for the possibility of implant removal and preservation of C1-C2 motion.