Neurosurgery
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Comparative Study
Intraoperative magnetic resonance imaging-guided neurosurgery at 3-T.
Between 1997 and 2004, more than 700 neurosurgical procedures were performed in a 1.5-T magnetic resonance-guided therapy suite. During this period, the concept of high-field intraoperative magnetic resonance imaging (MRI) was validated, as was a new surgical guidance tool, the Navigus (Image-guided Neurologics, Melbourne, FL), and its methodology, prospective stereotaxy. Clinical protocols were refined to optimize surgical techniques. That implementation, the "Minnesota suite," has recently been revised, and a new suite with a 3-T MRI scanner has been developed. ⋯ An intraoperative magnetic resonance-guided neurosurgical theater has been developed with a 3-T MRI scanner. Intraoperative imaging is feasible at this field strength, and concerns regarding specific absorption rate can be allayed. Infection control procedures can be designed to permit neurosurgery within this environment. Despite the increase in magnetic field strength, safety can be maintained.
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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.
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Comparative Study
Medial sphenoid wing meningiomas: clinical outcome and recurrence rate.
To provide clinical data concerning the visual outcome and recurrence rate of medial sphenoid wing meningiomas in consideration of two different subgroups of this tumor entity. ⋯ Group 1 meningiomas present a more favorable subgroup with fortunate visual outcome. In Group 2 tumors, visual improvement was less favorable and radical removal is limited because of cavernous sinus infiltration, with consequential higher recurrence rates. Patients harboring recurrent Group 2 tumors with deteriorating visual function profit from microsurgery because vision can be preserved on the same preoperative level in the majority.
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To describe a novel application of the Neuroform stent (Boston Scientific-Target, Fremont, CA) for the management of eight wide-necked aneurysms. ⋯ The Neuroform stent is a versatile device that can be used in a variety of ways to assist in the coiling of wide-necked aneurysms. The technique described here may be used for bifurcation aneurysms in lieu of using two stents in a Y configuration.
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Comparative Study
Endovascular treatment of unruptured intracranial aneurysms: occurrence of thromboembolic events.
The purpose of this study was to evaluate the frequency and causes of thromboembolic events associated with endovascular embolization of asymptomatic aneurysms. Correlations between radiological findings (aneurysm size, localization, embolization time, number of coils used, as well as patient age) were evaluated with the occurrence of thromboembolic events and clinical findings. ⋯ The high rate of thromboembolic events suggests that heparin is not sufficient to prevent ischemic lesions. An antiplatelet therapy, started before or during intervention, might diminish thrombus formation.