Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 2010
ReviewExpanded endonasal approaches to middle cranial fossa and posterior fossa tumors.
Skull base lesions that involve the middle and posterior cerebral fossae have been historically managed through extensive transcranial approaches. The development of endoscopic endonasal techniques during the past decade has made possible a vast array of alternative routes to the ventral skull base, providing the ability to expose lesions in difficult-to-access regions of the cranial base in a less invasive manner. In this review, the authors detail the endoscopic surgical anatomy and the operative nuances of the expanded endoscopic endonasal approaches to tumors of the middle and posterior cranial fossae. These techniques offer excellent exposure of the targeted regions yielding optimal resections, while avoiding the morbidity associated with transcranial surgical approaches.
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Neurosurg. Clin. N. Am. · Oct 2010
ReviewMinimally invasive surgery (endonasal) for anterior fossa and sellar tumors.
The primary goal of any surgical approach is to adequately visualize and treat the pathologic condition with minimal disruption to adjacent normal anatomy. The work of several researchers has revealed the promise of minimally invasive endonasal neurosurgery and paved the way for broader applications of the technology. This article discusses the current state of minimally invasive endonasal techniques to address the pathologic conditions of the anterior cranial fossa and parasellar region.
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Neurosurg. Clin. N. Am. · Oct 2010
ReviewApplication of technology for minimally invasive neurosurgery.
Minimally invasive neurosurgery has developed from technological innovations, including endoscopy, instrumentation, neuroimaging, stereotaxy, and others. This article highlights current technologies for minimally invasive cranial neurosurgery.
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Neurosurg. Clin. N. Am. · Oct 2010
ReviewComplication avoidance in minimally invasive neurosurgery.
Although minimally invasive neurosurgery (MIN) holds the potential for reducing the approach-related impact on normal brain, bone, and soft tissues, which must be manipulated in more conventional transcranial microneurosurgery, the techniques necessary to perform minimally invasive, yet maximally effective neurosurgery place significant demands on the surgeon because in many ways the more limited exposure creates a number of unique ways these operations can go wrong. Safe and effective MIN requires the conscious institution of specific alterations to the surgeon's usual operative case flow, which are designed to make specific well-known mistakes impossible or at least very unlikely. Thus, it is important for the aspiring MIN surgeons to learn from the mistakes of their predecessors and to institute patterns of behavior that prevent a repetition of these mistakes. This article provides practical information regarding known pitfalls in intraventricular and transcranial neuroendoscopic surgeries and practical methods to reduce the incidence of these complications to the lowest rate possible.
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Neurosurg. Clin. N. Am. · Jul 2010
ReviewIndirect revascularization techniques for treating moyamoya disease.
There have been many indirect revascularization techniques described by surgeons for the treatment of moyamoya disease. These surgical procedures are typically used more commonly in pediatric, than in adults', cases. Some of the techniques include: cervical sympathectomy, omental transplantation, multiple burr holes, encephalo-myo-synangiosis (EMS), encephalo-arterio-synangiosis (EAS), encephalo-duro-synangiosis (EDS), encephalo-myo-arterio-synangiosis (EMAS), encephalo-duro-arterio-synangiosis (EDAS), encephalo-duro-arterio-myo-synangiosis (EDAMS), encephalo-duro-galeo (periosteal)-synangiosis (EDGS), and combinations of all the above. This chapter will detail the technical aspects of many of these procedures and some of the reported clinical outcomes.