Neurosurgery
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Comparative Study
Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up.
To evaluate the midterm results of intracranial stent-assisted coil embolization in the treatment of wide-necked cerebral aneurysms and to assess the efficacy of various strategies used in stent deployment. ⋯ These results indicate that Neuroform stent-assisted coil embolization is a safe and effective technique in the treatment of wide-necked cerebral aneurysms. Further studies are needed to evaluate the long-term durability of stent-assisted aneurysm occlusion and tolerance to the stent.
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Comparative Study
Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke.
We have frequently observed the development of postoperative communicating hydrocephalus in patients undergoing decompressive hemicraniectomy. This condition may persist in some patients after cranioplasty and require permanent cerebrospinal fluid (CSF) diversion. To confirm an independent correlation between hemicraniectomy and the development of communicating hydrocephalus, and to detail the frequency and potential clinical factors contributing to this complication, we evaluated our series of patients undergoing hemicraniectomy for life-threatening increases in intracranial pressure secondary to ischemic or hemorrhagic stroke. ⋯ Communicating hydrocephalus is an almost universal finding in patients after hemicraniectomy. Delayed time to cranioplasty is linked with the development of persistent hydrocephalus, necessitating permanent CSF diversion in some patients. We propose that early cranioplasty, when possible, may restore normal intracranial pressure dynamics and prevent the need for permanent CSF diversion in patients after hemicraniectomy.
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Comparative Study
Atlanto-occipital dislocation: part 1--normal occipital condyle-C1 interval in 89 children.
Although atlanto-occipital dislocation has long been recognized as an extremely unstable and often lethal injury, no single radiodiagnostic criterion published to date has achieved failure-proof status. This is because most existing diagnostic tests exploit bony landmarks remote from the injured condyle-C1 (OC1) joint so that patient positioning could inadvertently line up these landmarks and conceal actual disruption of the joint. Many of the landmarks used are wide apart and/or noncoplanar; their measurements are subject to errors related to x-ray angle, target-film distance, and superimposed bony outlines. We propose using the actual occipital condyle-C1 interval (CCI) obtained from high-resolution reconstructed computed tomographic scans as the indicator for OC1 joint disruption. We hypothesize that the normal CCI is very small and has great left-right symmetry and that atlanto-occipital dislocation is always manifested by an abnormal widening of the CCI and/or by left-right joint asymmetry irrespective of the shifting of other remote bony landmarks. Part I of this study establishes standard normal values for CCI in children. ⋯ The normal OC1 joint in children 0 to 18 years is tightly held together by ligaments with a mean CCI of 1.28 mm in the 89 subjects tested. There is great left-right joint symmetry in both CCI and conformational anatomy. CCI and left-right symmetry do not appear to change significantly with age. It is reasonable to set a maximum CCI as a discriminator between normal and disrupted OC1 joints to indicate atlanto-occipital dislocation.
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Comparative Study
Nonoperative management of odontoid fractures using a halothoracic vest.
Despite various reports in the literature, the appropriate treatment of Type II odontoid fractures remains controversial. Although there is an increasing tendency toward surgical treatment of these fractures in recent years, nonoperative treatment strategies are still regarded as a practicable method, particularly in elderly patients with significant comorbidities. One purpose of this study was to determine the functional and radiographic long-term results after rigid immobilization of Type II odontoid fractures using a halothoracic vest. The second aim was to present a case-control series of patients with nonunion of Type II odontoid fractures compared with patients with successful fracture healing to determine specific risk factors for failure of halo immobilization. ⋯ With regard to successful fracture healing and functional results of the patients, we had a satisfactory outcome after halo fixation of Type II odontoid fractures. Although a fusion rate of 84% should not be deemed as optimal, nonoperative management of these fractures using a halothoracic vest seems to be an appropriate treatment strategy in patients who are not suitable for surgical treatment.
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To evaluate the clinical, endocrinological, and radiological presentation of nine cases of surgically verified intrasellar arachnoid cysts and to discuss the physiopathological mechanisms of formation of these cysts. ⋯ The clinical picture of an intrasellar arachnoid cyst resembles that of a nonfunctional pituitary adenoma. Magnetic resonance imaging scans typically show a cystic intrasellar lesion with suprasellar extension, containing isointense or, more often, hyperintense fluid on T1-weighted sequences. In spite of the risk of CSF fistulae, the preferred surgical approach is transsphenoidal. A physiopathological mechanism is proposed according to anatomic variations of the sellar diaphragma allowing penetration of subarachnoid spaces into the sellar compartment and their enlargement by a ball-valve mechanism.