Neurosurgery
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Comparative Study Clinical Trial
Novel dural closure technique using polyglactin acid sheet prevents cerebrospinal fluid leakage after spinal surgery.
Extradural or subcutaneous cerebrospinal fluid (CSF) leakage is a common complication after spinal surgery and is associated with the risks of poor wound healing, meningitis, and pseudomeningocele. Numerous methods to prevent postoperative CSF leakage are available, but pressure-tight dural closure remains difficult, especially with synthetic surgical membranes. The efficacy of a novel dural closure technique was assessed by detecting extradural or subcutaneous CSF leakage on magnetic resonance imaging. ⋯ The combination of polyglactin acid sheet and fibrin glue can achieve water-tight closure after spinal intradural surgery and can minimize the risk of intractable postoperative CSF leakage. This simple, economical technique is recommended for dural closure after spinal intradural surgery.
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Comparative Study Clinical Trial
Technical improvements and results of open-door expansive laminoplasty with hydroxyapatite implants for cervical myelopathy.
A new, modified technique of cervical open-door laminoplasty with hydroxyapatite implants was developed to enlarge the spinal canal in stable fashion yet preserve the architecture of the cervical spine and surrounding tissues. To assess the efficacy of this technique, a retrospective review of neurological and radiological outcomes after cervical laminoplasty was conducted. ⋯ A new modified technique of cervical open-door laminoplasty described herein offers some solutions to the problems associated with conventional techniques of cervical laminoplasty.
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Case Reports
Surgical management of osseous hemangioblastoma of the thoracic spine: technical case report.
Spinal hemangioblastomas usually occur as isolated, intramedullary, central nervous system masses, often as a component of von Hippel-Lindau syndrome. They may occasionally occur extradurally and give the appearance of vertebral hemangioma. Rarely, they may be purely osseous lesions. The surgical management of these lesions has not been elaborated. We present a case and discuss the management of multilevel osseous hemangioblastoma of the thoracic spine. ⋯ Although extremely rare, hemangioblastomas may occur in a purely osseous location. They may resemble vertebral hemangioma. Treatment should include aggressive surgical removal, although arduous, if appropriate. A bilateral lateral extracavitary approach is ideal for complete spondylectomy. With this technique, ventral and dorsal reconstruction of the spine through the same incision is possible.
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Comparative Study
Association between recurrent concussion and late-life cognitive impairment in retired professional football players.
Cerebral concussion is common in collision sports such as football, yet the chronic neurological effects of recurrent concussion are not well understood. The purpose of our study was to investigate the association between previous head injury and the likelihood of developing mild cognitive impairment (MCI) and Alzheimer's disease in a unique group of retired professional football players with previous head injury exposure. ⋯ Our findings suggest that the onset of dementia-related syndromes may be initiated by repetitive cerebral concussions in professional football players.
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Comparative Study Clinical Trial
Motor evoked potential monitoring during cerebral aneurysm surgery: technical aspects and comparison of transcranial and direct cortical stimulation.
This study evaluates technical aspects, handling, and safety of intraoperatively applied transcranial electrical stimulation (TES) and direct cortical stimulation (DCS) for eliciting muscle motor evoked potentials (mMEPs) during cerebral aneurysm surgery. ⋯ The cogent comprehensive combination of transcranial and direct cortical electrical stimulation allows for the continuous mMEP monitoring of the cerebral vascular territory of interest in 99% of the patients with cerebral aneurysms. Unwarranted effects of electrode placement and stimulation are rare and without clinical consequences.