Neurosurgery
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Review Meta Analysis
Treatment of ruptured intracranial aneurysms: looking to the past to register the future.
The outcomes reported in the International Subarachnoid Aneurysm Trial (ISAT), a multicenter, prospective, randomized trial to directly compare surgical clipping with endovascular coiling as treatments for ruptured intracranial aneurysms, have been misinterpreted by many to indicate the superiority of coiling to surgical clipping in all instances. To better understand the results of ISAT and their implications for practice patterns, we compared the ISAT results with the results of other published studies regarding the treatment of ruptured intracranial aneurysms. ⋯ Discrepancies with the results of other published studies, procedural limitations in study design, and lack of some data endpoints and subgroup analysis raise concerns regarding extracting generalizations from the conclusions of ISAT. We think that the creation of a national registry would further the study of treatment of ruptured intracranial aneurysms.
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To study the biomechanical behavior of lumbar interbody instrumentation techniques using titanium cages as either transforaminal lumbar interbody fusion (TLIF) or anterior lumbar interbody fusion (ALIF), with and without posterior pedicle fixation. ⋯ With pedicle screw fixation, the ALIF cage provides a higher segmental stability than the TLIF cage in flexion-extension and axial rotation, but the absolute biomechanical differences are minor. The different cage design and approach show only minor differences of segmental stability when combined with posterior pedicle screw fixation.
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Clinical Trial
Long-term results of microsurgical treatment of lumbar spinal stenosis by unilateral laminotomy for bilateral decompression.
Laminectomy and bilateral laminotomy are the standard procedures for decompression of lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability, the technique of unilateral laminotomy for bilateral decompression (ULBD) was developed. However, limited follow-up data exist to determine the efficiency and outcome of ULBD. Therefore, the authors present their 10-year experience with ULBD and postoperative long-term results. ⋯ ULBD allows achievement of good and long-lasting operative results in patients with LSS. Postoperative deterioration, recurrences, and spinal instability are infrequent. For the authors, ULBD is the preferred technique to treat symptomatic LSS.
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Controlled Clinical Trial
A population-based study of neurosurgical and endovascular treatment of ruptured, intracranial aneurysms in a small neurosurgical unit.
Since the introduction of endovascular embolization, the optimal treatment of ruptured aneurysms has been debated. Much of this debate has been based on results from large neurovascular centers and may not be applicable to small neurosurgical centers with low annual aneurysm loads. We think that the results of small centers, such as ours, may also be of some interest. ⋯ At present in our hospital, the endovascular modality seems to yield a better clinical outcome than surgery and has become our treatment of choice. With increasing use and further refinement of the endovascular techniques, the difference in outcomes between the treatment modalities will probably change even further in favor of the endovascular technique.
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Medically refractory cluster headache (CH) is a debilitating condition for which few surgical modalities have proven effective. Previous reports involving short-term follow-up of CH patients have reported modest degrees of pain relief after radiosurgery of the trigeminal nerve ipsilateral to symptom onset. With the recent success of deep brain stimulation as a surgical modality for these patients, it becomes imperative for the long-term risks and benefits of radiosurgery to be more extensively delineated. To address this issue, we present our findings from the largest retrospective series of patients undergoing radiosurgery for CH with extended follow-up periods. ⋯ Although some patients may experience short-term pain relief, none had relief sustainable for longer than 2 years. The results from this series indicate that radiosurgery of the trigeminal nerve does not provide long-term pain relief for medically refractory CH.