Minim Invas Neurosur
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Minim Invas Neurosur · Feb 2009
Review Controlled Clinical TrialRole of intraventricular sodium nitroprusside in vasospasm secondary to aneurysmal subarachnoid haemorrhage: a 5-year prospective study with review of the literature.
Cerebral vasospasm remains an important cause of permanent neurological injury and death following aneurysmal subarachnoid haemorrhage, despite the best current medical therapy. Sodium nitroprusside was recently suggested as a treatment option for cerebral ischaemia in patients with severe medically refractive vasospasm after subarachnoid haemorrhage. ⋯ Intraventricular sodium nitroprusside represents a promising method of treatment for established delayed cerebral vasospasm and cerebral ischaemia refractory to conventional treatment.
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Minim Invas Neurosur · Feb 2009
Case ReportsBilateral intracavernous carotid artery pseudoaneurysms as a result of sellar reconstruction during the transsphenoidal resection of a pituitary macroadenoma: case report.
Transsphenoidal surgery is considered to be a safe, relatively low risk procedure for the resection of pituitary lesions. Although rare, injury to the internal carotid artery is a potentially devastating complication associated with the transsphenoidal approach. The authors report a unique case in which the patient developed mirror pseudoaneurysms of the cavernous carotid arteries after an apparently uneventful transsphenoidal procedure, a complication attributed to the reconstruction of the sellar floor. ⋯ While considered to be a relatively safe procedure, the transsphenoidal approach for resection of pituitary lesions is not without risks. Injury to the internal carotid artery is arguably the most catastrophic complication seen with pituitary surgery. Although it typically occurs during the dural opening, or during tumor removal, this case illustrates that the neurosurgeon must be conscious of this risk throughout every aspect of the case. For cases when sellar reconstruction is performed, specific attention should be paid to ensuring that an appropriately sized graft is used.
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Minim Invas Neurosur · Feb 2009
Case ReportsDural arteriovenous fistula presenting as an acute subdural hemorrhage that subsequently progressed to a chronic subdural hemorrhage: case report.
Non-traumatic subdural hemorrhage (SDH) caused by dural arteriovenous fistula (DAVF) is rare and is usually accompanied by intracerebral hemorrhage (ICH) and/or subarachnoid hemorrhage (SAH). This report describes a very rare case of DAVF that caused non-traumatic acute SDH without ICH or SAH, which subsequently progressed into chronic SDH. ⋯ This is the first reported case of DAVF that caused non-traumatic progression to SDH. As DAVF can be the cause of acute and chronic SDH, cerebral angiography is recommended for non-traumatic acute SDH as well as for intractable chronic SDH.
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Minim Invas Neurosur · Feb 2009
Comparative StudyThree-dimensional neurostereoendoscopy: subjective and objective comparison to 2D.
Neuroendoscopic procedures, particularly transnasal skull-base procedures, are currently performed with 2D endoscopes that lack stereoscopic vision and depth of field. In principal, 3D vision should be preferable to the operating surgeon, but the previously existing systems have not been adopted. We evaluated a novel 3D endoscope to compare with 2D endoscopy. 33 neurosurgeons and skull-base otolaryngologists were recruited, and randomized to complete two runs of a task-based simulator paradigm using 2D and/or 3D visualization. ⋯ Subjects' speed and efficiency improved significantly when moving from 2D to 3D, and speed and efficiency improved significantly from Run 1 to Run 2 for 3D visualization. Subjective and objective outcomes support the utility of 3D visualization for neuroendoscopic techniques. Visualization that provides real-time, high-resolution binocular depth perception has a role in endoscopic skull base surgery and other neuroendoscopic procedures.
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Minim Invas Neurosur · Feb 2009
Surgical resection of high-grade gliomas in eloquent regions guided by blood oxygenation level dependent functional magnetic resonance imaging, diffusion tensor tractography, and intraoperative navigated 3D ultrasound.
The aims of this study of patients with high-grade gliomas in eloquent brain areas were 1) to assess the postoperative functional outcome, 2) to determine the extent of tumour resection in these difficult locations, 3) to evaluate the practical usefulness of navigated blood oxygenation level-dependent functional magnetic resonance imaging and diffusion tensor tractography. ⋯ We feel that the combination of blood oxygenation level-dependent functional magnetic resonance imaging, diffusion tensor tractography, and 3D ultrasound facilitated maximal tumour resection with minimal deficits. The method permits an image-based functional monitoring of the brain during surgery that may aid the preservation of motor and language function.