Minim Invas Neurosur
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Minim Invas Neurosur · Dec 2002
Case Reports"True" aneurysm of the posterior communicating artery as a possible effect of collateral circulation in a patient with occlusion of the internal carotid artery. A case study and literature review.
"True" posterior communicating artery (PCoA) aneurysms are extremely rare. A case of a 63-year-old patient with a ruptured "true" aneurysm of the right PCoA associated with the occlusion of the right internal carotid artery is presented. For nine years before he suffered from subarachnoid hemorrhage, the patient had developed symptoms of transient ischemic attack (TIA) due to the occlusion of the right internal carotid artery. ⋯ The patient was operated on and the aneurysm was clipped successfully. This case report suggests that the blood flow disturbances resulting from the collateral circulation through the PCoA could be a conductive factor in the formation and development of the aneurysm. This is the first described case of a "true" aneurysm of the PCoA coexistent with the occlusion of the internal carotid artery.
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Minim Invas Neurosur · Dec 2002
Case ReportsSuccessful obliteration of a ruptured partially thrombosed giant m1 fusiform aneurysm with coil embolization at distal m1 after extracranial-intracranial bypass.
Proximal occlusion or trapping combined with EC-IC bypass is usually employed as a definite treatment for a giant fusiform aneurysm in cases where it is impossible to apply clips and do vascular reconstruction. Endovascular treatment is very important as an alternative or combined technique if direct surgery is impossible. The authors report a young male who presented with a 2 nd episode of intracranial bleeding in basal ganglion and subarachnoid hemorrhage with mild right hemiparesis. ⋯ A month later when he was supposed to have his 2 nd coiling procedure his angiogram demonstrated spontaneous and complete obliteration of both the M1 and C3 aneurysms without any new neurological deficit, so no further endovascular procedure was attempted. The discussion is based on this case and previous reports regarding difficult giant M1 fusiform aneurysms, its treatment and spontaneous thrombosis of aneurysmal sac after bypass and distal occlusion. Conclusions are drawn that 1) spontaneous thrombosis of M1 and C3 aneurysms should be the result of hemodynamic alteration in both aneurysms due to a lower flow velocity induced by distal bypass and distal occlusion of M1, 2) combined distal bypass and endovascular obliteration of the aneurysmal sac with coils is a good alternative if vascular reconstruction is difficult or impossible.
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Minim Invas Neurosur · Dec 2002
Case ReportsTreatment of Chiari malformation, syringomyelia and hydrocephalus by neuroendoscopic third ventriculostomy.
This short paper illustrates a case with cervical myelomeningocoele, a Chiari malformation (CM), hydrocephalus (HC) and cervical syringomyelia treated by neuroendoscopic third ventriculostomy (NTV) with resolution of both the hydrocephalus and the syrinx. Two similar cases are discussed. The technique is advocated for the treatment of such complex dysraphic conditions.
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Minim Invas Neurosur · Dec 2002
Stereotactic guided laser-induced interstitial thermotherapy (SLITT) in gliomas with intraoperative morphologic monitoring in an open MR: clinical expierence.
Stereotactic guided laser-induced interstitial thermotherapy (SLITT) is a minimal invasive method to produce thermonecrosis in cerebral tumour tissue. Clinical data are sparse due to its limited application until now and the value of this approach for tumour control and survival time remain to be defined. Twenty-four patients (7 low-grade gliomas, 11 anaplastic gliomas, 6 glioblastomas) with brain tumours, most recurrences, were treated with SLITT, in total 30 laser procedures were performed. ⋯ SLITT for selected patients with glioma could have a clinical value in a multimodality treatment schedule maintaining quality of live. Due to the minimal invasive technique, the method is a therapy of choice and may be favoured to reoperation. Major indications of this treatment are small tumours, in eloquent regions and deep seated, as well as in older patients or patients in poor functional status.
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Adequate neural decompression with minimal structural alteration is the goal of lumbar stenosis surgery. Often because of limited visualization significant parts of the facet joints are removed enhancing the potential for developing instability. To overcome this problem we have developed a small curved Kerrison rongeur that contains a 10 000-pixel endoscope. This instrument allows one to visualize and decompress structures within the lateral recess that may have required more extensive removal of portions of the facet joints. ⋯ This instrument has the potential for less invasive decompression of spinal stenosis and further study of its utility is planned.