Journal of neurosurgery
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Journal of neurosurgery · May 2004
Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis.
Endoscopic techniques were introduced 7 years ago for the surgical management of patients with sagittal synostosis. In this study of 139 patients with sagittal synostosis, the authors assessed the efficacy, safety, complications, and outcomes after performing endoscopy-assisted wide-vertex craniectomies with bitemporal and biparietal barrel stave osteotomies. ⋯ Analysis of the results indicates that use of the aforedescribed procedure in the early treatment of infants with sagittal synostosis provides excellent outcomes and that the morbidity rate is lower than that associated with traditional cranial vault reconstruction. Detailed anthropometric and radiographic analyses demonstrated that with adequate helmet therapy in our patients normocephaly was achieved and maintained without the need for secondary operations.
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Journal of neurosurgery · May 2004
Randomized Controlled Trial Clinical TrialA pilot trial comparing cerebral perfusion pressure-targeted therapy to intracranial pressure-targeted therapy in children with severe traumatic brain injury.
The authors sought to compare cerebral perfusion pressure (CPP)- with intracranial pressure (ICP)-targeted therapy in children with severe traumatic brain injury (TBI). ⋯ The CPP method appears to be safe, although this feasibility study does not establish that the CPP therapy is superior to ICP therapy.
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The purpose of this study was to define the topographic anatomy, arterial supply, and venous drainage of the insula and sylvian fissure. ⋯ The majority of gyri and sulci of the frontoparietal and temporal opercula had a constant relationship to the insular gyri and sulci and provided landmarks for approaching different parts of the insula. The most lateral lenticulostriate artery, an important landmark in insular surgery, arose 14.6 mm from the apex of the insula and penetrated the anterior perforated substance 15.3 mm medial to the limen insulae. The superior trunk of the middle cerebral artery (MCA) and its branches supplied the anterior, middle, and posterior short gyri; the anterior limiting sulcus; the short sulci; and the insular apex. The inferior trunk supplied the posterior long gyrus, inferior limiting sulcus, and limen area in most hemispheres. Both of these trunks frequently contributed to the supply of the central insular sulcus and the anterior long gyrus. The areas of insular supply of the superior and inferior trunks did not overlap. The most constant insular area of supply by the cortical MCA branches was from the prefrontal and precentral arteries that supplied the anterior and middle short gyri, respectively. The largest insular perforating arteries usually arose from the central and angular arteries and most commonly entered the posterior half of the central insular sulcus and posterior long gyrus. Insular veins drained predominantly to the deep middle cerebral vein, although frequent connections to the superficial venous system were found. Of all the insular veins, the precentral insular vein was the one that most commonly connected to the superficial sylvian vein.
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Journal of neurosurgery · May 2004
Advances in the endoscopic management of suprasellar arachnoid cysts in children.
Suprasellar arachnoid cysts present unique management problems. The authors retrospectively reviewed six cases, in which endoscopic ventriculocystocisternotomy was performed, to identify specific neuroimaging features that aid both the accurate diagnosis of this entity and the postoperative assessment of fenestration patency. ⋯ To aid in the accurate diagnosis of prepontine arachnoid cysts, the authors identified several pathognomonic features on sagittal MR images: vertical deflection of the optic chiasm and mammillary bodies, as well as pontine effacement. Dual endoscopic fenestration into the intraventricular compartment and basal cistern is safe, and it effectively provides symptomatic relief by decreasing the cyst size. Triplanar flow-sensitive MR imaging sequences can confirm fenestration patency without the need for cine-mode MR imaging.