Minim Invas Neurosur
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Minim Invas Neurosur · Feb 2007
Clinical TrialLaparoscopic neurolysis of the sacral plexus and the sciatic nerve for extensive endometriosis of the pelvic wall.
The aim of this study is to report on the feasibility of laparoscopic neurolysis of the plexus sacralis and the sciatic nerve in deep endometriotic infiltration of the lateral pelvic wall. ⋯ In young patients with chronic unilateral sciatica or unilateral pudendal neuralgia - Alcock's canal syndrome - where no neurological/orthopedic etiologies have been found, endometriotic infiltration of the lateral pelvic wall has to be implicated as a potential etiology and an indication for laparoscopy must be discussed. Laparoscopic neurolysis of the pelvic somatic nerves is a feasible procedure for trained laparoscopic surgeons who have a good knowledge of the retroperitoneal pelvic (neuro)anatomy.
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Minim Invas Neurosur · Feb 2007
Minimally invasive decompression for lumbar spinal canal stenosis in younger age patients could lead to higher stresses in the remaining neural arch -- a finite element investigation.
A young patient group with the symptoms of acquired spinal stenosis has been identified recently in the literature. The patients between 25-50 years of age were found to have signs of lumbar spinal stenosis because of degenerative spinal changes. Some of them were operated on using the same limited decompression approaches as the older patients. However, this group differs from the geriatric population due to the scarcity of remodeling degenerative signs at the spine. Therefore, the possible ligamentous laxity, facet joint degeneration or only the removal of some spinal structures could lead to the increased stresses in the remaining spinal arch and could have an unfavorable course of events after the procedure. A biomechanical study has been done using an experimentally validated finite element model (FEM) of the intact L3-S1 lumbar spine to elucidate the influence of the limited decompression on range of motion (ROM) and stress distribution on the neural arch in this patient group. ⋯ The investigation revealed almost the same ROM after simulation but a considerable increase in stresses at both the pars interarticularis and the inferior facet after limited decompressions, especially in extension and rotation to the contralateral side. Stresses at the contralateral L4 pedicle were highest after L4 hemilaminectomy and medial facetectomy L4-5. Due to the observed increases in stresses, the surgeon should be aware of the possibilities of stress-fractures in this patient group.
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This study was made to define the mechanism of endoscopic third ventriculostomy (ETV) in the various forms of hydrocephalus. ⋯ The relatively high rate of success of ETV in various forms of hydrocephalus and the intraoperative finding of mobility of the third ventricle floor after the stomy suggest that the first mechanism of the ETV is the restoration of pulsatility of the ventricular walls. This results in restoration of the CSF flow from the ventricular system into the subarachnoid spaces and normalization of the CSF dynamics. Accordingly, ETV is not only an internal shunt, but it primarily influences the capacity of the brain pulsatility to ensure CSF flow.
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Minim Invas Neurosur · Dec 2006
Microvascular decompression for trigeminal neuralgia: a long-term follow-up study.
In this report, we present our experience with microvascular decompression (MVD) as treatment for trigeminal neuralgia (TN) and discuss factors related to recurrence after this procedure. Between 1986 and 2004, 90 patients underwent MVD for treatment of idiopathic TN at the Marmara University Department of Neurosurgery and Marmara University Neurological Sciences Institute. Individuals with atypical and secondary forms of TN were excluded from the study. ⋯ There was no mortality associated with MVD in the 90 cases. The findings for our series of 90 patients with TN who underwent MVD indicate that this operation is an effective and reliable treatment for this condition. We recommend MVD as the first-line surgical approach for patients with TN who do not respond to medical management.
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Minim Invas Neurosur · Oct 2006
Clinical TrialA pterion keyhole approach for the treatment of anterior circulation aneurysms.
The supraorbital keyhole approach is most frequently used in treatment for lesions within the anterior cranial base. However, it has some drawbacks, including cosmetically poor appearance of the scar, forehead deformity, and difficulty in dealing with some kinds of middle cerebral artery (MCA) and internal carotid artery (ICA) aneurysms. Therefore, we have developed a small pterion keyhole approach for an alternative access to treat anterior circulation aneurysms. ⋯ No approach-related complication occurred except that one patient had vasospasm 2 days after the aneurysm clipping. In conclusion, this pterion keyhole approach can achieve the best operative effect for the treatment of intracranial anterior circulation aneurysms in a selective group of patients with several advantages over traditional craniotomy including minor tissue damage, less brain retraction, a superior cosmetic result, and shorter duration of surgery. Moreover, the operative field becomes wider in the deep area, providing sufficient space for microscope-assisted surgery without the need for highly specialized instruments.