Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Aug 2013
Case ReportsMedial posterior choroidal artery territory infarction associated with tumor removal in the pineal/tectum/thalamus region through the occipital transtentorial approach.
Damage to the deep venous system, occipital lobe, and/or corpus callosum is well known to cause complications associated with the occipital transtentorial approach (OTA), but ischemic complications are not well documented. The authors investigated the high incidences of ischemic complications associated with removal of pineal/tectal/thalamic tumors through the OTA. ⋯ A relatively high incidence of MPChA territory infarction was associated with removal of tumors in the pineal/tectal/thalamic region through the OTA. Eye symptoms often occurred post-surgery and tended to persist in these patients. Neurosurgeons must be aware of the possibility of MPChA territory infarction to further increase the safety of the OTA.
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Clin Neurol Neurosurg · Aug 2013
Excessively elevated C-reactive protein after surgery for temporal lobe epilepsy.
We present a series of 87 patients who underwent anteromesial temporal lobe resections for therapy refractory temporal lobe epilepsy. In addition to seizure outcome, we observed excessively elevated CRP-levels in this patient population. ⋯ Seizure outcome after surgery for temporal lobe epilepsy was excellent, CRP levels were excessively elevated in these patients in the absence of clinical infection and significantly higher compared to resections of supratentorial lesions.
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Clin Neurol Neurosurg · Aug 2013
Cranioplasty after decompressive hemicraniectomy: underestimated surgery-associated complications?
Decompressive hemicraniectomy (DC) and duroplasty after malignant brain infarction or traumatic brain injury is a common surgical procedure. Usually, preserved bone flaps are being reimplanted after resolution of brain swelling. Alloplast cranioplasties are seldom directly implanted due to the risk of wound healing disorders. While numerous studies deal with DC, little is known about the encountered problems of bone flap reimplantation. Thus, aim of the study was to identify surgery-associated complications after bone flap reimplantation. ⋯ Almost one-third of the patients that are operated on for bone flap reimplantation after DC suffer from surgery-associated complications. Most often, wound healing disorders as well as bone flap resorption lead to a second or even third operation with the need for artificial bone implantation. These results might raise the question, if subsequent operations can be avoided, if an artificial bone is initially chosen for cranioplasty.
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Clin Neurol Neurosurg · Aug 2013
Multicenter StudyProtecting facet joints post-lumbar discectomy: Barricaid annular closure device reduces risk of facet degeneration.
Lumbar discectomy is an effective treatment for lumbar disc herniation (LDH). Although the majority of patients experience successful outcomes, a significant fraction will experience a recurrence of their back pain due to facet joint degeneration. Facet joint degeneration after discectomy may be the result of excessive nuclear removal, disc space narrowing, and annular injury. ⋯ CT interpretations were collected preoperatively and 12 months post-discectomy. Patients implanted with Barricaid had significantly reduced rates and grades of facet degeneration than patients without Barricaid. Reinforcing the annulus fibrosus with Barricaid during lumbar discectomy may slow the progression of facet joint degeneration.