Journal of neurosurgery
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Journal of neurosurgery · Mar 2002
Brachial plexus neurotization with donor phrenic nerves and its effect on pulmonary function.
To examine possible side effects of neurotizations in which the phrenic nerve was used, pulmonary function was analyzed pre- and postoperatively in patients with brachial plexus injury and root avulsions. ⋯ When the right phrenic nerve is used as a donor in neurotization of the musculocutaneous nerve, the patient incurs a higher risk of reduced pulmonary VC. If possible, the left phrenic nerve should be preferred. The Pi(max) has to be determined preoperatively to avoid any further decrease in the already reduced pulmonary function due to the initial injury.
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Journal of neurosurgery · Mar 2002
Trigeminal schwannomas: removal of dumbbell-shaped tumors through the expanded Meckel cave and outcomes of cranial nerve function.
As in patients with vestibular schwannomas, advances in surgical procedures have markedly improved outcomes in patients with trigeminal schwannomas. In this article the authors address the function of cranial nerves in a series of patients with trigeminal schwannomas that were treated with gross-total surgical removal. The authors emphasize a technique they use to remove a dumbbell-shaped tumor through the expanded Meckel cave, and discuss the advantage of the extradural zygomatic middle fossa approach for total removal of tumor and preservation or improvement of cranial nerve function. ⋯ Preservation or improvement of cranial nerve function can be achieved through total removal of a trigeminal schwannoma, and skull base approaches are better suited to achieving this goal. The zygomatic middle fossa approach is particularly helpful and safe. It allows extradural tumor removal from the cavernous sinus, the infratemporal fossa, and the posterior fossa through the expanded Meckel cave.
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Journal of neurosurgery · Mar 2002
Cerebrospinal fluid leaks following spinal surgery: use of fat grafts for prevention and repair. Technical note.
Cerebrospinal fluid (CSF) leaks are relatively common following spinal surgery. A midline dural tear in the spine is readily repaired by direct application of sutures; however, far-lateral or ventral dural tears are problematic. Fat is an ideal sealant because it is impermeable to water. ⋯ There was one case of postoperative CSF leakage in 140 cases in which intradural exploration for tumor or other lesions was undertaken. Both postoperative CSF leaks were controlled by applying additional skin sutures. The use of a fat graft is recommended as a rapid, effective means of prevention and repair of CSF leaks following spinal surgery.