Neurosurgery
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Comparative Study
Socioeconomic costs of open surgery and gamma knife radiosurgery for benign cranial base tumors.
The aim of this study was to evaluate the relative socioeconomic costs of benign cranial base tumors treated with open surgery and gamma knife radiosurgery. ⋯ Most of the socioeconomic loss with open surgery for benign cranial base tumors comes from the indirect costs of workdays lost and mortality. Gamma knife radiosurgery is a worthwhile treatment to our patients and to our society because it may shorten hospital stays and workdays lost and reduce complications, mortality, socioeconomic loss, and achieve better cost-effectiveness.
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Comparative Study
Minimally invasive lateral mass screw fixation in the cervical spine: initial clinical experience with long-term follow-up.
Lateral mass screw fixation of the subaxial cervical spine has been a major advancement for spinal surgeons. This technique provides excellent three-dimensional fixation from C3 to C7. However, exposure of the dorsal spinal musculature can produce significant postoperative neck pain. The incorporation of a minimal access approach using tubular dilator retractors can potentially overcome the drawbacks associated with the extensive muscle stripping needed for traditional surgical exposures. ⋯ A minimally invasive approach using tubular dilator retractors can be a safe and effective means for placing lateral mass screws in the subaxial cervical spine. Up to two levels can be treated in this manner. This approach preserves the integrity of the muscles and ligaments that maintain the posterior tension band of the cervical spine but requires adequate intraoperative imaging.
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Comparative Study Clinical Trial
Dual electrode thalamic deep brain stimulation for the treatment of posttraumatic and multiple sclerosis tremor.
To report the results of ventralis intermedius nucleus/ventralis oralis posterior nucleus (VIM) plus ventralis oralis anterior (VOA)/ventralis oralis posterior (VOP) thalamic deep brain stimulation (DBS) for the treatment of posttraumatic and multiple sclerosis tremor. ⋯ Tremors, such as those examined in this study, that are refractory to medications and have a poor response to VIM DBS monotherapy, may respond favorably to VIM plus VOA/VOP DBS. Two electrodes may be better than one for the treatment of certain disorders; however, more study will be required to confirm this hypothesis.
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Comparative Study
One-piece versus two-piece orbitozygomatic craniotomy: quantitative and qualitative considerations.
The orbitozygomatic (OZ) craniotomy minimizes brain retraction and improves cranial base exposure by providing a multidirectional view, increased operative angles and working space. The two main variations of the approach include the one-piece and the two-piece types. The microsurgical anatomy of the one- and two-piece OZ craniotomies are presented with the goal of comparing the extent of orbital roof removal between these two craniotomies and the effect of orbital roof removal on operative exposure. ⋯ The two-piece OZ craniotomy allows for more extensive orbital roof removal and better visualization of the basal frontal lobe. Therefore, the two-piece may result in a lower incidence of enophtalmus and poor cosmetic outcomes, particularly if the remaining orbital roof must be removed piecemeal during the one-piece OZ craniotomy in order to obtain satisfactory exposure.