Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · May 2014
Hemorrhage after stereotactic biopsy from intra-axial brain lesions: incidence and avoidance.
With the introduction of stereotactic surgery in humans by Spiegel and Wycis in 1947 and the great advances in neuroimaging, image-guided stereotactic brain biopsy is the mainstay for diagnosis of intrinsic deep-seated brain lesions. Stereotactic biopsy is usually safe, and the reported rate of complications is minimal, with mortality being reported in less than 1% and significant morbidity occurring in less than 5%. The complication most often encountered after stereotactic biopsy is hemorrhage. ⋯ Using multiplanar image-guided trajectory planning and a small biopsy needle decreases the incidence of post-biopsy hemorrhage. Neurologically intact patients with no hemorrhage in post-biopsy CT scan could safely be discharged home at the same operative day.
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J Neurol Surg A Cent Eur Neurosurg · May 2014
On-call service of neurosurgeons in Germany: organization, use of communication services, and personal acceptance of modern technologies.
A significant proportion of acute care neurosurgical patients present to hospital outside regular working hours. The objective of our study was to evaluate the structure of neurosurgical on-call services in Germany, the use of modern communication devices and teleradiology services, and the personal acceptance of modern technologies by neurosurgeons. ⋯ Teleradiology services were observed to be widely used by on-call neurosurgeons in Germany. Nevertheless, a significant number of departments appear to use outdated techniques or techniques that leave patient data unprotected. On-call neurosurgeons in Germany report a willingness to adopt more modern approaches, utilizing readily available smartphones or tablet technology.
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J Neurol Surg A Cent Eur Neurosurg · May 2014
Comparative StudyA novel microendoscopically assisted approach for the treatment of recurrent lumbar disc herniation: transosseous discectomy surgery.
Microendoscopic discectomy (MED) is still regarded as contraindicated for the treatment of recurrent lumbar disc herniation by many surgeons. Moreover, the presence of epidural scar tissue makes surgical manipulation difficult. To successfully remove the herniated disc in such cases, an open technique with a wide exposure may be required. We devised a new minimally invasive endoscopic approach, which is using a transosseous route. This is a retrospective review of a consecutive case series to examine the operative and clinical results of this new approach. ⋯ TD is a safe and effective surgical approach for the treatment of recurrent lumbar disc herniation. Operative time, intraoperative blood loss, and clinical results compare favorably with MED.
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J Neurol Surg A Cent Eur Neurosurg · May 2014
Outcomes after endoscopic port surgery for spontaneous intracerebral hematomas.
Spontaneous intracerebral hemorrhages (ICHs) cause significant morbidity and mortality. Traditional open surgical management strategies offer limited benefit except for the most superficial hemorrhages in select patients. Recent reports suggest that endoscopic approaches may improve outcomes, particularly for deep subcortical hemorrhages. However, the management of these patients remains controversial. We reviewed our experience using endoscopic port surgery to identify characteristics that may predict acceptable outcomes. ⋯ Our series demonstrates that endoscopic port surgery for acute intracerebral hematoma evacuation has the ability to achieve significant decompression of large and deep-seated hematomas. Patient age, extent of evacuation, laterality, and preoperative hematoma volume appear to influence patient outcome. Most overall outcomes remain poor. Future studies are necessary to determine if surgical evacuation is in fact superior to best medical treatment and if so, to validate, refute, or further identify characteristics that define surgical candidates.
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J Neurol Surg A Cent Eur Neurosurg · Mar 2014
Diagnostic value of brain tumor neuroendoscopic biopsy and correlation with open tumor resection.
The risks of stereotactic biopsy are increased not only in tumors located in the vicinity of vascular structures, but also in cystic, intraventricular, and periventricular lesions. The use of neuroendoscopy for cystic, intraventricular, or periventricular brain tumors is particularly advantageous because of the possibility of biopsy and immediate hemostasis under direct vision. Neuroendoscopy provides the possibility of controlling tumor-associated obstructive hydrocephalus by means of endoscopic third ventriculostomy or septostomy. The literature gives good evidence for the diagnostic benefits of neuroendoscopic biopsy. The correlation of the histology obtained by neuroendoscopic biopsy and subsequent surgical resection may allow the evaluation of the validity of diagnostic neuroendoscopic biopsy. ⋯ The diagnostic accuracy of neuroendoscopic biopsy samples can be compared with the results of stereotactic biopsy. The histological results of endoscopically taken biopsy samples and the final histological results obtained during open surgery correlate in the majority of patients, and underlines the high diagnostic validity of neuroendoscopic biopsy.