Journal of neurological surgery. Part A, Central European neurosurgery
-
J Neurol Surg A Cent Eur Neurosurg · Nov 2013
Randomized Controlled Trial Comparative StudyA prospective, randomized, controlled trial comparing radiographic and clinical outcomes between stand-alone lateral interbody lumbar fusion with either silicate calcium phosphate or rh-BMP2.
Iliac crest autograft has traditionally been considered the gold standard for lumbar spine fusion, though it is not without drawbacks related to harvesting site pain and other complications. Bone graft alternatives, such as recombinant human bone morphogenetic protein 2 (rh-BMP2), are now widely used but also have unique risk profiles and substantially increase costs. The purpose of the current study was to compare the efficacy of rh-BMP2 and synthetic silicate calcium phosphate (SiCaP) as bone graft substitutes on fusion rates and clinical outcomes in patients undergoing single-level lumbar stand-alone extreme lateral interbody fusion (XLIF). ⋯ In stand-alone XLIF, SiCaP and rhBMP-2 bone graft substitutes both resulted in complete long-term fusion. rhBMP-2, however, seemed to result in more rapid early postoperative fusion, though with one instance of excessive bone formation in one patient that required subsequent surgical intervention.
-
J Neurol Surg A Cent Eur Neurosurg · Nov 2013
Single-Incision laparoscopic surgery (SILS) for ventriculoperitoneal shunt placement.
Single-incision laparoscopic surgery (SILS) may facilitate safer shunt placement and lower distal obstruction rate than is seen in conventional surgery. ⋯ SILS is a safe and effective technique for ventriculoperitoneal shunt placement and can be accomplished with no higher risk of shunt infection and distal malfunction. Without an additional port, SILS allows good visualization of the peritoneal cavity to avoid major intra-abdominal complications. Only one 6-mm incision at the umbilicus area is required and is almost invisible after wound healing.
-
J Neurol Surg A Cent Eur Neurosurg · Nov 2013
Comparative StudyThree-dimensional high-definition neuroendoscopic surgery: a controlled comparative laboratory study with two-dimensional endoscopy and clinical application.
The purpose of this research was to investigate the usefulness of three-dimensional (3D) endoscopy compared with two-dimensional (2D) endoscopy in neuroendoscopic surgeries in a comparative study and to test the clinical applications. ⋯ The use of a 3D neuroendoscope improved depth perception and task performance. Our results suggest that 3D endoscopes could shorten the learning curve of young neurosurgeons and play an important role in both general surgery and neurosurgery.
-
J Neurol Surg A Cent Eur Neurosurg · Nov 2013
The modified pterional keyhole craniotomy for open cerebrovascular surgery: a new workhorse?
The frontotemporal craniotomy is the most commonly used approach for vascular neurosurgery. However, this approach requires significant mobilization of overlying soft tissues, resulting in muscle atrophy and temporomandibular joint pain. We describe a modified pterional keyhole approach and its use in our initial clinical experience. ⋯ In carefully selected patients, a minimally invasive keyhole approach may be a safe and effective alternative to traditional pterional craniotomy for certain anterior circulation aneurysms.
-
J Neurol Surg A Cent Eur Neurosurg · Sep 2013
Case ReportsConversion of local anesthesia-guided deep brain stimulation of the subthalamic nucleus to general anesthesia.
Deep brain stimulation of the subthalamic nucleus (STN) is a widely applied procedure in the treatment of patients with advanced Parkinson disease and is generally performed under local anesthesia. Here we report our experience with the conversion to general anesthesia in two patients with advanced Parkinson disease because of fear reactions intraoperatively. ⋯ Our case observations document the possibility of fear reactions intraoperatively and show the possibility of conversion to general anesthesia with a successful outcome.