British journal of neurosurgery
-
Comparative Study
A comparison of magnetic resonance imaging and neurophysiological studies in the assessment of cervical radiculopathy.
Neurophysiological studies (NPS) are often used by both neurosurgeons and neurologists to supplement neuroimaging findings in the diagnosis of cervical radiculopathy and in operative decision-making. The aim of this study was to assess whether nerve conduction and electromyographic studies added significant information to that obtained from high resolution MRI to warrant routine use. Over the 10-year period (1991-2001), we identified 48 patients who underwent both preoperative NPS and MRI for cervical radiculopathy. ⋯ Whilst the positive predictive values for MRI and NPS were similar (91% versus 86%), the former had a higher negative predictive value (25% versus 7%). In only one case was the decision to operate based on NPS despite a negative MRI. We therefore suggest that in patients with clinical and MRI evidence of cervical radiculopathy, NPS has limited additional diagnostic value.
-
Over recent years frameless stereotactic systems have begun replacing framed systems for many neurosurgical procedures. However, little has been published regarding the use of these systems to guide intracranial electrode implantation for epilepsy surgery patients. Here we report our experience utilising such a system to insert depth electrodes and subdural grid electrodes. ⋯ The only long-term complication was a case of osteomyelitis which required removal of the bone flap. 73% of patients had an excellent seizure outcome. Frameless stereotactic systems can be safely used to intracranial electrodes, avoid the disadvantages of the framed system and have the added advantage of the surgeon being able to visualise the trajectory and to adjust this to avoid vital structures. As well they eliminate surgical obstruction to the insertion of subdural grids at the same operation, which may be caused by a framed system.
-
Treatments of atlanto-axial rotatory subluxation in children are generally conservative. Previous reports have proposed that surgical treatment be reserved for fixed rotatory subluxation of more than 3 months duration, irreducible deformity or cases of recurrence. Six skeletally immature patients with Fielding type III atlanto-axial rotatory subluxation were treated conservatively with or without subsequent atlanto-axial arthrodesis. ⋯ Neither mortality nor major morbidity was noted in any cases in this study. In our experience, type III fixed rotatory subluxation of 6 weeks duration will potentially recur. We recommend early surgery for type III fixed rotatory subluxation of more than than 3 months' duration, with atlanto-axial arthrodesis being a safe and effective procedure in children.
-
We describe an apparently unique case of a patient with a trigeminal neuralgia caused by compression of the trigeminal nerve during its course by the draining vein of a developmental venous anomaly in the cerebellopontine angle. Typical symptoms of trigeminal neuralgia disappeared completely after microvascular decompression of the nerve. Neuroradiological findings, as well as particularities of this case are described and therapeutic options are discussed.
-
Neurosurgical care is limited in many parts of the world to one or two hospitals serving a large geographic area. The quality of neurosurgical response to emergencies depends on the reliability and completeness of the information received from referral hospitals. The aim of this study is to show how application of guidelines for head injury management in an entire area can be usefully combined with transmission of images from the peripheral to the central hospital. ⋯ Unnecessary transfers can be avoided and the neurosurgeons can evaluate the images of a number of patients who have always been treated outside our Units. This results in more work for the neurosurgeons on duty, but also in a better quality service for the whole area. The lack of follow-up for patients not admitted to Neurosurgery is the limitation on a quality assessment of the system.