Neurosurgery
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Case Reports
Sublabial approach for the treatment of symptomatic basilar impression in a patient with Klippel-Feil syndrome.
Basilar impression (BI) is an uncommon condition in which there is upward displacement of the elements forming the foramen magnum, causing translocation of vertebral elements into the brainstem. Most commonly a developmental anomaly, BI is often associated with congenital conditions such as Down syndrome. Symptomatic BI is often difficult to treat surgically secondary to the anatomic variants associated with many of the coinciding congenital syndromes. ⋯ The sublabial route is an alternative approach for anterior decompression in patients with symptomatic basilar impression and altered anatomic circumstances such as that caused by Klippel-Feil syndrome.
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The incidence of traumatic craniocervical artery dissection varies in published trauma series. ⋯ Whole-body trauma computed tomography with an adapted scanning protocol for the craniocervical vessels is a fast, safe, and feasible method for detecting vascular injuries. It allows prompt further treatment if necessary. Computed tomography angiography could be a part of a broad screening protocol for craniocervical vessels in documented injuries of the head and neck and in trauma mechanisms influencing the craniocervical region as well.
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Imaging technologies have evolved to meet the demand for improved presurgical simulations, particularly with the introduction of endoscopic surgery in the neurosurgical field. ⋯ Our 3-dimensional imaging method is superior to conventional methods and will greatly improve the safety and effectiveness of neuroendoscopic surgical procedures for complex intraventricular lesions.
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Evaluating intrathecal baclofen (ITB) delivery systems for potential malfunction can be challenging. The catheter systems are prone to myriad complications that are frequently difficult to ascertain by conventional imaging techniques. Newer imaging technologies and their combinations can be used to identify such problems, define surgical indications, and focus operative planning. C-arm fluoroscopy and C-arm cone beam CT performed in one imaging session represents one such combination that has great utility. ⋯ Combined CF and CCBCT proved highly effective in the evaluation of our patients with potential ITB system malfunctions. This technique is advocated for such evaluations because it accurately defines problems with connectivity, integrity, and position of catheter systems. When surgical intervention is required, this information aids in operative planning.
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Case Reports
Successful anterior capsulotomy in comorbid anorexia nervosa and obsessive-compulsive disorder: case report.
State-of-the-art treatment of anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) often proves ineffective. Both disorders have common features, and anterior capsulotomy is a last-resort treatment for OCD. We document the effect of bilateral anterior capsulotomy in a patient with comorbid AN and OCD. ⋯ This case report suggests that bilateral anterior capsulotomy can be a therapeutic option for patients with comorbid AN and OCD. However, a well-controlled study is warranted.