Neurosurgery
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We report on 32 neonates treated with ventriculosubgaleal (VSG) shunts to determine VSG shunt survival and associated complications. ⋯ VSG shunts offer a simple, effective, and relatively safe means of temporizing hydrocephalus, and they avoid the need for external drainage or frequent CSF aspiration in these medically unstable infants until the CSF characteristics and abdomen are acceptable for ventriculoperitoneal shunting.
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Case Reports
A keyhole approach for endoscopically assisted pedicle screw fixation in lumbar spine instability.
The standard approach for dorsal transpedicular fixation in lumbar spine instability requires extensive exposure of the vertebral column. This increases the risk of potential complications and possibly destabilizes healthy neighboring segments because of the dissection and denervation of paravertebral muscles. The majority of spinal disorders are currently treated successfully via limited and tailored approaches. Accordingly, a keyhole approach for dorsal fusion of the lumbar spine was developed on the basis of an anatomic study. ⋯ This new approach significantly reduces surgical traumatization and destabilization of adjacent motion segments. An endoscopic operating sheath, adopted from thoracoscopic surgery, creates space for visualization and surgical manipulations. The newly defined anatomic landmarks provide guidance to the screw entry point into the pedicle in the center of the exposure. Observation of the exact corresponding angles of convergence during screw insertion by an inclinometer facilitates correct screw placement. In accordance with the initial anatomic studies, this approach was successfully performed on 12 cadavers and then used in six patients. Two illustrative cases are presented.
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This study investigated the cerebral blood flow (CBF) thresholds of ischemic cortices that were salvageable with intravenous tissue plasminogen activator (t-PA) infusion therapy. ⋯ To save ischemic tissue with our intravenous t-PA infusion therapy, residual CBF should be at least 45% of the contralateral presumed normal CBF value. CBF thresholds for ischemia that would be surely salvageable with our intravenous t-PA infusion therapy might be approximately 50 to 55% of the contralateral presumed normal CBF values.
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Providing relief of symptomatic radiculopathy resulting from sacral perineural cysts has proven difficult. Our goal was to improve the treatment of these cysts with microsurgical cyst fenestration and imbrication, while minimizing functional damage to neural tissues. ⋯ Microsurgical cyst fenestration and imbrication are effective treatments for long-term relief of refractory painful radiculopathy and urinary incontinence associated with large sacral perineural cysts.
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Delayed epistaxis resulting from trauma to branches of the external carotid artery is an infrequent but potentially serious complication of transsphenoidal surgery. We report two cases of severe, delayed epistaxis in patients who had undergone transsphenoidal surgery. In both cases, noninvasive treatment failed, necessitating endovascular intervention. ⋯ Delayed massive epistaxis is a rare but significant complication of transsphenoidal surgery. Injury to branches of the external carotid artery, along with injury to the internal carotid artery, should be suspected in patients who present with delayed epistaxis after transsphenoidal surgery. Angiography performed in patients with refractory bleeding should include selective external carotid injections. Epistaxis that is refractory to anterior and posterior nasal packing may be effectively treated with endovascular embolization.