Journal of neurosurgery
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Journal of neurosurgery · Sep 2014
New endoscopic route to the temporal horn of the lateral ventricle: surgical simulation and morphometric assessment.
The temporal horn of the lateral ventricle is a complex structure affected by specific pathological conditions. Current approaches to the temporal horn involve a certain amount of corticotomy and white matter disruption. Surgeons therefore set aside anterior temporal lobectomy as a last resource and avoid it in the dominant hemisphere. The authors propose a minimally invasive endoscopic intraventricular approach to the temporal horn and describe a standardized analysis and technical assessment of the feasibility of this approach. ⋯ In this study, the endoscopic intraventricular approach to the temporal horn is standardized. The morphometric analysis makes this approach anatomically feasible and replicable. This approach provides minimally invasive endoscopic access to the uncal recess, amygdala, hippocampus, fornix, and paraventricular temporal lobe structures. The following essential strategies enabled access to and maneuverability inside the temporal horn: tailored preoperative planning of the trajectory and use of anatomical and radiological references, constant irrigation, and an angled endoscopic lens. Safety assessment and novel instruments and techniques may be proposed to advance this very promising route to pathological changes in the temporal lobe.
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Journal of neurosurgery · Sep 2014
Case ReportsSimultaneous subependymomas in monozygotic female twins: further evidence for a common genetic or developmental disorder background.
In this paper, a rare case of subependymoma of the fourth ventricle in identical female twins is reported. Magnetic resonance imaging and CT showed nearly identical locations of the tumors in the fourth ventricle and similar growth patterns of the tumors in both sisters. ⋯ If symptomatic, a subependymoma can in some cases lead to sudden death caused by pressure on the brainstem or decompensated secondary hydrocephalus. This case demonstrates the importance of detecting tumors early and thereby preventing symptoms arising from increasing intracranial pressure, and optimizing therapy options.
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Journal of neurosurgery · Sep 2014
Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery.
Care providers have put significant effort into optimizing patient safety and quality of care. Value, defined as meaningful outcomes achieved per dollar spent, is emerging as a promising framework to redesign health care. Scarce data exist regarding cost measurement and containment for episodes of neurosurgical care. The authors assessed how cost measurement and strategic containment could be used to optimize the value of delivered care after the implementation and maturation of quality improvement initiatives. ⋯ Linking cost-containment and cost-reduction strategies to ongoing outcome improvement measures is an important step toward the optimization of value-based delivery of care.
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Journal of neurosurgery · Sep 2014
The guillotine knife: a novel tool for safe endoscopic cutting of intracranial membranes.
This article describes a new endoscopic cutting tool that acts like a guillotine. It enables safe cutting of membranes overlying neurovascular structures because the footplate protects these structures from inadvertent injury. ⋯ The guillotine knife has been used in various endoscopic procedures such as septostomies, arachnoid cyst fenestrations, colloid cysts resections, and fenestrations of other intraventricular membranes. The authors think that the guillotine knife is a useful addition to the neuroendoscopic armamentarium.
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Journal of neurosurgery · Sep 2014
Patients' cosmetic satisfaction, pain, and functional outcomes after supraorbital craniotomy through an eyebrow incision.
The supraorbital approach through an eyebrow incision offers the opportunity to access a wide variety of lesions of the anterior, middle, and even the posterior fossa. The minimally invasive keyhole craniotomy limits brain exploration and retraction and offers the potential for improved surgical outcomes and reduced approach-related complications. Patient satisfaction, however, has not yet been reported in the literature. ⋯ The supraorbital approach to the anterior, middle, and posterior fossae through an eyebrow incision offers a favorable rate of approach-associated surgical complications and high patient satisfaction with cosmetic outcome.