Neurosurgery
-
Comparative Study
Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion: a retrospective review.
The anterior lumbar interbody fusion (ALIF) procedure has become an accepted fusion technique for treating patients with degenerative disorders of the lumbar spine. Many consider laparoscopic ALIF to be the least invasive approach. A modification of the open laparotomy--the "mini-open" approach--is an attractive alternative. In this retrospective review, a comparison of these two ALIF approaches is presented. ⋯ Both the laparoscopic and mini-open techniques are effective approaches to use when performing ALIF procedures. On the basis of the data obtained in this retrospective review, the laparoscopic approach does not seem to have a definitive advantage over the mini-open exposure, particularly in an L5-S1 ALIF procedure. In our opinion, the mini-open approach possesses a number of theoretical advantages; however, the individual surgeon's preference ultimately is likely to be the dictating factor.
-
To assess the role that neuronavigation plays in assisting endoscopic transsphenoidal reoperations for recurrent pituitary adenomas. ⋯ Neuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and probably safer.
-
Posterior circulation aneurysms can be difficult lesions to treat surgically, and they have potential for high morbidity and mortality, particularly in elderly patients or those in poor neurological condition. In an effort to improve outcomes, our combined neurosurgical and neuroendovascular unit has used both surgical clipping and endovascular coiling techniques to treat posterior circulation aneurysms. Patients considered at high risk for surgery were managed with endovascular treatment. ⋯ A combined surgical and endovascular approach to posterior circulation aneurysms can achieve good outcomes in high-risk surgical patients treated by use of coiling techniques.
-
Endoscopic third ventriculostomy (ETV) is currently the principal alternative to cerebrospinal fluid shunt placement in the management of pediatric hydrocephalus. Cost-effectiveness analysis can help determine the optimal strategy for integrating these different approaches. ⋯ In this matched cohort, ETV was not significantly less costly or more effective over a median 35 months of follow-up, with a 54% initial ETV success rate, even before the additional morbidity and mortality encountered were taken into account. The time course for the accrued costs suggests that a larger cohort, longer follow-up, or higher success rates are needed to demonstrate the cost-effectiveness of this therapy.
-
This study was performed to evaluate the clinical manifestations and prognostic factors for outcomes among patients with nontuberculous spinal epidural abscesses. ⋯ Surgical decompression combined with antimicrobial therapy remains the recommended treatment. In addition to abscess locations and motor deficits, inflammatory markers such as WBC counts and C-reactive protein levels are prognostic for outcomes.