Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Nov 2012
Minimally invasive transpedicular dorsal stabilization of the thoracolumbar and lumbar spine using the minimal access non-traumatic insertion system (MANTIS): preliminary clinical results in 52 patients.
The aim of this study is to report about a preliminary experience with a new minimally invasive percutaneous transpedicular dorsal stabilization system (MANTIS, Stryker, Kalamazoo, MI, USA) for thoracolumbar and lumbar spinal diseases to demonstrate the benefits of the operative technique and drawbacks. ⋯ Minimally invasive transpedicular screw stabilization systems such as the MANTIS lead to safe and effective procedures. They can be used for different spinal disorders and can be combined with additional surgical procedures such as intervertebral fusion or decompression, if necessary.
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J Neurol Surg A Cent Eur Neurosurg · Nov 2012
Clinical outcome of subthalamic stimulation in Parkinson's disease is improved by intraoperative multiple trajectories microelectrode recording.
The use of multiple trajectories microelectrode recording (MER) during implantation of deep brain stimulation (DBS) electrodes into the subthalamic nucleus (STN) in patients with Parkinson's disease (PD) is discussed controversially because of possible risks and unclear benefits. The aim of the study is to investigate whether MER combined with intraoperative evaluation of stimulation effects improve clinical outcome in PD patients undergoing STN DBS surgery. ⋯ DBS surgery based on intraoperative multiple trajectories MER and test stimulation improves clinical outcome if compared with intraoperative test stimulation alone. The data suggest that DBS surgery solely based on MRI and intraoperative test stimulation without MER may lead to nonoptimal placement of DBS electrodes and consequently poorer clinical outcome.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
ReviewManagement of arteriovenous malformations related to Spetzler-Martin grading system.
Advanced technology and improved understanding of the natural history of arteriovenous malformations (AVMs) led to the reconsideration of the management of these lesions, which once comprised purely microsurgical removal. A multidisciplinary approach for both the evaluation and treatment of AVMs has gained acceptance within the past few decades. ⋯ The risk of a chosen management strategy must include the sum of the risk of all the interventions applied to a given lesion, and this should be compared with the natural history of a given lesion in a particular clinical setting. Among all components of the multimodality treatment, however, microsurgical removal remains the definitive form of treatment.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
Comparative StudyTranscranial microsurgical and endoscopic endonasal cavernous sinus (CS) anatomy: a cadaveric study.
Even in the era of tremendous microneurosurgical and endoscopic development, the cavernous sinus (CS) is a challenging anatomical site for a neurosurgeon. Many transcranial and a few endoscopic cadaveric studies have been done to study the CS; probably none were undertaken to study its microsurgical and endoscopic anatomy side by side. In this cadaveric study we perform a side-by-side comparison of the microsurgical and endoscopic anatomy of the CS that can help neurosurgeons deal with CS lesions more efficiently. ⋯ Microscopic and endoscopic exposure of the CS is relatively easy in cadavers. But endoscopic or microsurgical exposure of the CS during surgery is more difficult requiring skill. With experience of the cadaveric study , the CS may be explored via transcranial microsurgery, endonasal endoscopy, or both simultaneously, according to the nature and extension of the pathology.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
Case ReportsAvoidance of electrode related MRI artifact during staged deep brain stimulator implantation.
Centers implanting deep brain stimulator (DBS) electrodes on different days often protect the first electrode tip with a protective cap, tunnel it under the scalp, and connect it to the generator at a later procedure. If magnetic resonance imaging (MRI) is used for planning during the second implantation, MRI artifacts from the protective cap could potentially corrupt the stereotactic coordinates. The importance of this problem may increase if emerging MRI safety data lead to more frequent use of MRI for these purposes. ⋯ A silastic sleeve provides adequate protection of the DBS electrode during staged implantation and avoids the MRI artifact associated with protective caps with screws.