Neurosurgery
-
Comparative Study
Endovascular surgery for proximal posterior inferior cerebellar artery aneurysms: an analysis of Glasgow Outcome Score by Hunt-Hess grades.
Proximal posterior inferior cerebellar artery (PICA) aneurysms represent a subset of posterior circulation aneurysms that can be routinely treated with either clipping or coiling. The literature contains limited numbers of patients with proximal PICA aneurysms treated with endovascular surgery. We report our experience with endovascular surgery of proximal PICA aneurysms with emphasis on patients with poor Hunt-Hess grades. ⋯ This series demonstrates the safety and efficacy of endovascular surgery for proximal PICA aneurysms. Many patients with poor Hunt-Hess grades from ruptured PICA aneurysms ultimately had a good outcome. This could be secondary to early, aggressive treatment of hydrocephalus and the minimally invasive nature of the endovascular approach.
-
Comparative Study Clinical Trial
The utility of intraoperative blood flow measurement during aneurysm surgery using an ultrasonic perivascular flow probe.
Inadvertent vessel compromise is one major cause of unfavorable outcome from aneurysm surgery. Existing strategies for intraoperative assessment of this complication have potential limitations and disadvantages. We assessed the utility of quantitative intraoperative flow measurements using the Transonic ultrasonic flow probe (Transonic Systems, Inc., Ithaca, NY) during aneurysm surgery. ⋯ Use of the ultrasonic flow probe provides real-time immediate feedback concerning vessel patency. Vessel compromise is easier to interpret than with Doppler, and faster/less invasive than intraoperative angiography. Intraoperative flow measurement is a valuable adjunct for enhancing the safety of aneurysm surgery.
-
Comparative Study Clinical Trial
Single-stage thoracolumbar vertebrectomy with circumferential reconstruction and arthrodesis: surgical technique and results in 15 patients.
Circumferential reconstruction and arthrodesis can be necessary after thoracolumbar vertebrectomy. The authors describe a technique for single-stage thoracolumbar vertebrectomy with circumferential reconstruction and arthrodesis. The surgical results using this technique are reviewed. ⋯ The authors present a method for thoracolumbar vertebrectomy, circumferential reconstruction, and arthrodesis performed in a single stage, solely via a posterior approach. This is an alternative to anterior (i.e., thoracoabdominal and retroperitoneal) and lateral (i.e., lateral extracavitary) approaches that can be used for circumferential reconstruction and arthrodesis. Potential advantages and pitfalls are discussed.
-
Case Reports
Video-assisted thoracoscopic dissection of the brachial plexus: cadaveric study and illustrative case.
Standard surgical approaches to the brachial plexus require an open operative technique with extensive soft tissue dissection. A transthoracic endoscopic approach using video-assisted thoracoscopic surgery (VATS) was studied as an alternative direct operative corridor to the proximal inferior brachial plexus. ⋯ VATS provided an alternative surgical corridor to the proximal inferior brachial plexus and obviated the need for the extensive soft tissue dissection associated with the anterior supraclavicular and posterior subscapular approaches.
-
Comparative Study
Efficacy of postural reduction in osteoporotic vertebral compression fractures followed by percutaneous vertebroplasty.
Vertebroplasty in the symptomatic osteoporotic vertebral fracture has become increasingly popular. However, there have been some limitations in restoring the height of the collapsed vertebrae and in preventing the leaking of cement. In the severely collapsed vertebrae of more than two thirds of their original height, vertebroplasty is regarded as a contraindication. We tried postural reduction using a soft pillow under the compressed level. This study was undertaken to investigate the effectiveness of the combination of postural reduction and vertebroplasty for re-expansion and stabilization of the osteoporotic vertebral fractures. ⋯ This new method of vertebroplasty leads to significant restoration of height and correction of kyphosis. The re-expansion was closely related with onset duration. In cases of severely collapsed vertebrae which is able to be re-expanded by postural reduction, vertebroplasty could be applied safely.