Journal of neurosurgery
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The orbitozygomatic approach provides wide, multidirectional access to the anterior and middle cranial fossae, as well as to the upper third of the posterior fossa and clivus. The authors describe technical details of the surgical approach as it has evolved over 3.5 years of experience in 83 consecutive cases. This modified technique eliminates the need for bone reconstruction of the orbital walls to prevent enophthalmos and minimizes the risk of injury to the frontal branch of the facial nerve. At a follow-up evaluation after a period averaging 14 months, all patients were pleased with the cosmetic results of this approach.
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Journal of neurosurgery · Aug 1998
Comparative StudyThoracoscopic microsurgical excision of herniated thoracic discs.
The authors began using thoracoscopy to treat pathological conditions of the spine in 1992. In this study they delineate their clinical experience in which this procedure was used to resect herniated thoracic discs. ⋯ Thoracoscopic microdiscectomy is a reliable surgical technique that can be performed safely with excellent clinical and neurological results.
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Journal of neurosurgery · Aug 1998
Gamma knife radiosurgery as a lesioning technique in movement disorder surgery.
To increase knowledge of the safety and efficacy of the use of gamma knife radiosurgery in patients with movement disorders, the authors describe their own experience in this field and include blinded independent assessments of their results. ⋯ Functional lesions may be made safely and accurately using gamma knife radiosurgical techniques. The efficacy is equivalent to that reported for open techniques that use radiofrequency lesioning methods with electrophysiological guidance. Complications are very infrequent with the radiosurgical method. The use of functional radiosurgical lesioning to treat movement disorders is particularly attractive in older patients and in those with major systemic diseases or coagulopathies; its use in the general movement disorder population seems reasonable as well.
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Journal of neurosurgery · Aug 1998
Case ReportsCranioplasty performed with a new osteoconductive osteoinducing hydroxyapatite-derived material.
Cranioplasty is required to protect underlying brain, correct major aesthetic deformities, or both. The ideal material for this purpose is autogenous bone. When this is not available, alloplastic or artificial materials may be used. These materials should be malleable, strong, lightweight, inert, noncarcinogenic, nonferromagnetic, and, if possible, inexpensive. The authors reviewed their surgical experience with a new bone substitute and discuss outcomes in patients in whom it was used. ⋯ In the near future, this technique may be refined to achieve good or excellent results either without the use of supporting material or with the use of individual, computer-designed 3-D prostheses.
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Journal of neurosurgery · Aug 1998
Comparative StudyRelationships among cerebral perfusion pressure, autoregulation, and transcranial Doppler waveform: a modeling study.
The aim of this study was to analyze how the main values extrapolated from the transcranial Doppler (TCD) waveform (systolic, mean, and diastolic velocity; velocity peak-to-peak amplitude; and pulsatility index [PI]) are affected by changes in intracranial pressure (ICP), systemic arterial pressure (SAP), autoregulation, and intracranial compliance. ⋯ The information contained in the TCD waveform is affected by many factors, including ICP, SAP, autoregulation. and intracranial compliance. Model results indicate that only a comparative analysis of the concomitant changes in ultrasonographic quantities during multimodality monitoring may permit the assessment of several aspects of intracranial dynamics (cerebral blood flow changes, vascular pulsatility, ICP changes, intracranial compliance, CPP, and autoregulation).