Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
-
This study was undertaken to determine variables that could predict, in the preoperative period, the likelihood for the need for intraoperative temporary arterial occlusion using clips (temporary clipping) when surgically repairing intracranial aneurysms. Data collected prospectively between October 1989 and March 2010 of 1129 unruptured intracranial aneurysms in 934 patients who were managed surgically was examined retrospectively. Temporary clipping was used in 400 patients (35.4%). ⋯ Basilar caput aneurysms larger than 10mm were always managed with temporary clipping. There was no combination of factors studied that consistently predicted that temporary clipping would not be needed. Therefore, the potential need for temporary clipping must be considered for every patient with an aneurysm.
-
Growing skull fracture (GSF) is an uncommon but well recognized complication of calvarial fracture in infancy and early childhood. The condition is rare in adults, and involvement of the skull base in this group of patients affects mostly the orbital roof. ⋯ The patient recovered well after a limited transcranial repair with preservation of olfactory function. A high index of suspicion should be exercised in the management of patients who present with these symptoms even many years after injury.
-
Between March 2003 and September 2007, 170 consecutive patients with lumbar degenerative disease were studied retrospectively. Eighty patients underwent posterior lumbar interbody fusion (PLIF group) with pedicle screw (PS) fixation, and 82 patients underwent posterolateral fusion (PLF group) with PS fixation. Eight patients were lost to follow-up. ⋯ Twenty-two of 162 patients (14%) underwent a second operation: 18 (22%) in the PLF group and four (5%) patients in the PLIF group (p<0.001). The clinical and functional outcomes in both groups were similar, and no significant difference was found in the parameters tested. Both surgical procedures were effective, but patients in the PLF group showed more complications related to hardware biomechanics than patients in the PLIF group (p<0.001).
-
Despite the literature supporting the efficacy of kyphoplasty for treatment of osteoporotic vertebral compression fractures in multiple myeloma, few reports exist documenting its use in the treatment of malignant vertebral compression fractures (MVCF) caused by metastases. Accordingly, we sought to evaluate the feasibility, efficacy and safety of kyphoplasty in the treatment of MVCF without epidural involvement. We performed a retrospective review of clinical outcome data for 48 patients with multiple spinal metastases treated with kyphoplasty. ⋯ The mean visual analog scale score decreased significantly from presurgery to postsurgery (7.4 ± 2.1 to 3.8 ± 1.6; p<0.001), as did the Oswestry Disability Index score (71.5 ± 16.7 to 32.4 ± 9.6; p<0.001). The SF-36 scores for bodily pain, physical function, vitality, and social functioning all also showed significant improvement (p<0.05). Kyphoplasty is an effective, minimally invasive procedure for the stabilization of pathological vertebral fractures caused by metastatic disease, even in levels with vertebral wall deficiency, leading to a statistically significant reduction in pain, improvement in function and prevention of further kyphotic deformity of the spine.
-
Before the advent of minimally invasive spine surgery (MIS), open transforaminal lumbar interbody fusion (TLIF) was performed to treat spondylosis, spondylolisthesis, and spondylolysis. Minimally invasive TLIF has recently become more popular based upon the premise that a smaller, less traumatic incision should afford better recovery and outcomes. However, the learning curve associated with this technique must be considered. ⋯ Patients who underwent MIS TLIF had a statistically significant lower intraoperative transfusion rate, and rate of required postoperative surgical drains; and shorter periods of required drainage, and time to ambulation. However, the MIS TLIF group tended to have a higher rate of complications, which might have been associated with the learning curve. Both groups had a minimum of 1-year follow-up.