Journal of neurosurgery
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Journal of neurosurgery · Mar 2013
Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery.
Hearing loss after Gamma Knife surgery (GKS) in patients with vestibular schwannoma has been associated with radiation dose to the cochlea. The purpose of this study was to evaluate serviceable hearing preservation in patients with VS who were treated with GKS and to determine if serviceable hearing loss can be correlated with the dose to the cochlea. ⋯ With a median mean cochlear dose of 2.7 Gy, the majority of patients with serviceable hearing retained serviceable hearing 3 years after GKS. A mean cochlear dose less than 3 Gy was associated with higher serviceable hearing preservation.
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Journal of neurosurgery · Mar 2013
Identification of venous sinus, tumor location, and pial supply during meningioma surgery by transdural indocyanine green videography.
Indocyanine green (ICG) videography is commonly used in the neurosurgical field for minimally invasive neurosurgery. The aim of this study was to evaluate a new intraoperative imaging modality by performing transdural ICG videography during surgery for meningiomas. ⋯ Prior to opening of the dura mater, transdural ICG videography was used successfully to visualize the dural attachment of meningiomas and the venous sinus, resulting in safe and appropriate dural opening. The diminishment of the total and partial eclipse signs may represent significant feeding from the intracranial arteries and a tendency to bleed during resection.
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Journal of neurosurgery · Mar 2013
Decreasing ventricular infections through the use of a ventriculostomy placement bundle: experience at a single institution.
Ventricular infection after ventriculostomy placement carries a high mortality rate. Responding to ventriculostomy infection rates, a multidisciplinary performance improvement team was formed, a comprehensive protocol for ventriculostomy placement was developed, and the efficacy was evaluated. ⋯ Bundle implementation including an antimicrobial-impregnated catheter dramatically decreased EVD-related infections. Training and situational awareness of appropriate practice, assisted by the checklist, plus use of the antibiotic-impregnated catheter resulted in sustained reduction in ventriculitis.
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Journal of neurosurgery · Mar 2013
Long-term safety and efficacy of stereotactic radiosurgery for vestibular schwannomas: evaluation of 440 patients more than 10 years after treatment with Gamma Knife surgery.
Object Little is known about long-term outcomes, including tumor control and adverse radiation effects, in patients harboring vestibular schwannomas (VSs) treated with stereotactic radiosurgery > 10 years previously. The aim of this study was to confirm whether Gamma Knife surgery (GKS) for VSs continues to be safe and effective > 10 years after treatment. Methods A total of 440 patients with VS (including neurofibromatosis Type 2) treated with GKS between May 1991 and December 2000 were evaluable. ⋯ Conclusions In this study GKS was a safe and effective treatment for the majority of patients followed > 10 years after treatment. Special attention should be paid to cyst formation and malignant transformation as late adverse radiation effects, although they appeared to be rare. However, it is necessary to collect further long-term follow-up data before making conclusions about the long-term safety and efficacy of GKS, especially for young patients with VSs.
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Journal of neurosurgery · Mar 2013
Outcome after transfer of intercostal nerves to the nerve of triceps long head in 25 adult patients with total brachial plexus root avulsion injury.
The intercostal nerves (ICNs) have been used to repair the triceps branch in some organizations in the world, but the reported results differ significantly. The effect of this procedure requires evaluation. Thus, this study aimed to evaluate the outcome of ICN transfer to the nerve of the long head of the triceps muscle and to determine the factors affecting the outcome of this procedure. ⋯ The transfer of ICNs to the nerve of long head of the triceps is an effective procedure for treating global brachial plexus avulsion injuries, even if combined with phrenic nerve transfer to the biceps branch. Two ICNs appear to be sufficient for donation. The earlier the surgery is performed, the better are the results achieved.