Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jun 2015
Multicenter StudyPrimary decompressive craniectomy for poor-grade middle cerebral artery aneurysms with associated intracerebral hemorrhage.
Aggressive surgery seems mandatory for poor-grade middle cerebral artery (MCA) aneurysm with associated intracerebral hemorrhage (ICH). However, primary decompressive craniectomy (DC) is controversial. We performed a case control study to define the role of primary DC. ⋯ Although primary DC does not increase postoperative complication and mortality risk, current results showed primary DC does not seem to be significantly associated with improved outcomes. However, more than one half of patients most benefit from primary DC. Further prospective controlled studies are warranted to clarify the issue.
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Clin Neurol Neurosurg · Jun 2015
Surgery of brain aneurysm in a BrainSuite(®) theater: A review of 105 cases.
The BrainSuite(®) is a highly integrated operating theater designed mainly for brain tumor surgery. The issues concerning its routine use in vascular neurosurgery have not been discussed in literature to date. We report our experience of surgical treatment of cerebral aneurysms in the BrainSuite(®), with a view to evaluating safety, feasibility, advantages, disadvantages, and contraindications. ⋯ A total of 105 patients were included in this report. Of these, 39 and 66 were affected, respectively, by ruptured and unruptured aneurysms. The mean age was 56.1 and the male-to-female ratio was 1:2.9. The aneurysms affected, with progressively descending incidence, the MCA, ACoA, ICA bifurcation, PComA, A2, A1-A2, and C6 segment of the ICA in 40 (38.1%), 23 (22%), 15 (14.3%), 7 (6.6%), 7 (6.6%), 7 (6.6%), and 6 (5.8%) cases, respectively. The aneurysms were clipped and completely excluded from blood circulation in all cases and no difficulty was encountered in positioning and fixing the patients' heads, despite the particular head holder of the BrainSuite(®). MRI created no interference or problems in cases of carotid exposure at the neck, while harvesting of the lower-limb saphenous vein was not feasible due to the vicinity of the operating field to the magnet. Intraoperative angiography was never performed since an angiogram is not compatible with the BrainSuite. Intraoperative DWI, MRA, and volumetric MRI proved to be effective tools for post-clipping evaluation of the patency of the parent vessels and their collateral branches as well as of aneurismal occlusion. This was also checked doubly by availing also of intraoperative micro Doppler ultrasonography. Intraoperative DWI also permitted us to evaluate the presence of initial ischemic lesions as possible consequences of both direct arterial occlusion and early vasospasm related to surgical manipulation. Intraoperative navigation of brain aneurysm with 3D-model reconstructions may be of some use to younger surgeons when planning the clipping strategies and localizing the aneurysm particularly in cases, respectively, of large-complex aneurysms where the sac involves collateral branches and small aneurisms affecting both distal ACA and MCA aneurysms. The outcomes for patients, evaluated according to the GOS (Glasgow outcome score), associated significantly with the preoperative HH (Hunt and Hess) scale grading. Patients with high HH scores (IV and V) in particular showed the highest incidence of unfavorable outcome (GOS=1 or 2) CONCLUSIONS: The BrainSuite(®) theater is completely suited to brain aneurysm surgery but only in cases where a combined endovascular approach may be required. It provides some advantages and few limitations compared to a normally-equipped neurosurgical operating theater; our experience shows that the technological advances of this complex operating room are useful though not essential in aneurysm surgery.
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Clin Neurol Neurosurg · Jun 2015
The strategy and early clinical outcome of full-endoscopic L5/S1 discectomy through interlaminar approach.
To analyze the surgical strategy, safety and clinical outcome of full-endoscopic discectomy through interlaminar approach in the case of L5/S1 intervertebral disc excision. ⋯ With proper selection between axilla approach and shoulder approach according to the sites of prolapsed or sequestered disc materials, full-endoscopic L5/S1 discectomy through interlaminar approach is a safe, rational and effective minimally invasive spine surgery technique with excellent clinical short-term outcomes.