Neurosurgical review
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Neurosurgical review · Jan 2013
Results of microsurgical treatment of paraclinoid carotid aneurysms.
The term "paraclinoid aneurysms", has been used for aneurysms of the internal carotid artery (ICA) between the cavernous sinus and the posterior communicating artery. Due to their complex anatomical relationship at the skull base and because they are frequently large/giant, their surgical treatment remains a challenge. Ninety-five patients harboring 106 paraclinoid aneurysms underwent surgery (1990-2010). ⋯ The most frequent deficits were visual impairment and third cranial nerve palsies. Operative mortality was 11.6%, all in patients presenting with ruptured aneurysms. Despite relatively high morbidity/mortality, especially for patients with ruptured aneurysms, microsurgical treatment of paraclinoid aneurysm has high efficacy, with better outcome for unruptured aneurysms and worse outcome for patients with vasospasm.
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Neurosurgical review · Jan 2013
Case ReportsEndoscope-integrated ICG technology: first application during intracranial aneurysm surgery.
Microscopic indocyanine green videoangiography (mICG-VA) has gained wide acceptance during intracranial aneurysm surgery by lowering rates of incomplete clipping and occlusion of surrounding vessels. However, mICG-VA images are limited to the microscopic view and some deeper areas, including the aneurysm sac/neck posterior side, cannot be efficiently assessed as they are hidden by the aneurysm, clips, or surrounding structures. Contrarily, endoscopes allow a wider area of visualization, but neurosurgical endoscopes to date only provided visual data. ⋯ Obtaining eICG sequences required currently the microscope to be moved away from the operating field. eICG-VA was only recorded under infrared illumination which prevented tissue handling, but white-infrared light views could be interchanged instantaneously. Further development of angled endoscopes integrating the ICG technology and dedicated filters blocking the microscopic light could improve visualization capacities even further. In conclusion, as a result of its ability to reveal structures around corners, the eICG-VA technology could be beneficial when used in combination with mICG-VA to visualize and confirm vessel patency in areas that were previously hidden from the microscope.
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Neurosurgical review · Jan 2013
Long-term follow-up of ruptured intracranial aneurysms treated by microsurgical wrapping with autologous muscle.
The purpose of this study is to describe our series of nine unclippable and uncoilable ruptured aneurysms in eight patients treated by microsurgical wrapping with autologous muscle. Records were retrospectively reviewed for rebleeding rate, morbidity and mortality, changes in size or the aneurysm's configurations, and inflammatory reaction. We conducted a Medline search in the post-microsurgical era, excluding patients in whom wrapping was part of the aneurysm treatment in combination with clipping or coiling. ⋯ Follow-up MR demonstrated persistence of the aneurysm's sac, without changes in size and configuration. Patients did not describe or exhibit symptoms attributable to complications inherent to the use of muscle. Microsurgical muscle-wrapping of ruptured intracranial aneurysm is safe, is associated with a low rate of acute and delayed postoperative complications and rebleeding, and could be a valid alternative for unclippable and non-amenable to endovascular procedure ruptured aneurysms.
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Neurosurgical review · Jan 2013
Comparative StudyChronic subdural haematomas: a comparative study of an enlarged single burr hole versus double burr hole drainage.
Various surgical treatments have been proposed for the treatment of chronic subdural haematoma (CSDH). Herewith, we set out to compare the efficacy of an enlarged single burr hole versus double burr hole drainage for the treatment of CSDH. We studied patients with symptomatic CSDH proven by CT scan that were treated in our institute between January 2002 and January 2009. ⋯ The mean hospitalization time was 6.2 days, and there was no significant difference between the two groups. No significant difference was found between patients' outcome, as assessed by Glasgow outcome scale score, and treatment method. Enlarged single burr hole and double burr hole drainage had the same efficacy in the treatment of CSDH.
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Neurosurgical review · Jan 2013
Comparative StudyComparison of navigated transcranial magnetic stimulation and functional magnetic resonance imaging for preoperative mapping in rolandic tumor surgery.
Navigated transcranial magnetic stimulation (nTMS) is a novel tool for preoperative functional mapping. It detects eloquent cortical areas directly, comparable to intraoperative direct cortical stimulation (DCS). The aim of this study was to evaluate the advantage of nTMS in comparison with functional magnetic resonance imaging (fMRI) in the clinical setting. ⋯ Using nTMS, a preoperative localization of the central sulcus was possible in all patients. Verification of nTMS motor cortex localization with DCS was achieved in all cases. The fMRI localization of the hand area proved to be postcentral in one case. nTMS has fewer restrictions for preoperative functional mapping than fMRI and requires only a limited level of compliance. nTMS scores higher on the accuracy scale than fMRI. nTMS represents a highly valuable supplement for the preoperative functional planning in the clinical routine.