Minim Invas Neurosur
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Minim Invas Neurosur · Jun 2005
Three-dimensional computed tomographic anatomy of the abdominal great vessels pertinent to L4-L5 anterior lumbar interbody fusion.
A recent accumulation of surgical and radiological literature has helped spine surgeons to better understand the anatomy and establish surgical trajectories to the anterior L4-L5 disc space. However, the preoperative display of anatomic data in individual subjects in the three-dimensional (3-D) mode has rarely been attempted. The objective of this study was to acquire 3-D images of the abdominal great vessels pertinent to the L4-L5 anterior lumbar interbody fusion (ALIF), and to better define the radiological vascular anatomy. ⋯ The MSA and L4 segmental artery were identified in 79 and 83 subjects, respectively. The 3-D images of the abdominal great vessels together with the lumbar spinal column were reliably depicted. Anatomic data obtained from this study are in accordance with those obtained from conventional 2-D studies, and the 3-D images can serve as a versatile tool for preoperative evaluation for the ALIF candidates and can contribute to the reduction of surgical time and perioperative vascular complications.
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Minim Invas Neurosur · Jun 2005
Indications for neuroendoscopic aqueductoplasty without stenting for obstructive hydrocephalus due to aqueductal stenosis.
Neuroendoscopic aqueductoplasty (EAP) is a curative and radical procedure for obstructive hydrocephalus due to aqueductal stenosis that re-establishes the physiological circulation of cerebrospinal fluid (CSF). We assessed the indications for safe neuroendoscopic aqueductoplasty without stenting to treat aqueductal stenosis. ⋯ EAP can be considered the best surgical procedure for restoring physiological circulation of CSF in patients with obstructive hydrocephalus caused by aqueductal stenosis. However, EAP candidates must be selected very carefully using the following indications: 1) obstructive triventricular hydrocephalus with increased intracranial pressure, 2) translucent membranous stenosis or aqueduct obstruction, and 3) prestenotic dilatation of the aqueduct.
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Minim Invas Neurosur · Apr 2005
Biomechanical rationale of endoscopic decompression for lumbar spondylolysis as an effective minimally invasive procedure - a study based on the finite element analysis.
We evaluated the biomechanical behavior of the endoscopic decompression for lumbar spondylolysis using the finite element technique. An experimentally validated, 3-dimensional, non-linear finite element model of the intact L3 - 5 segment was modified to create the L4 bilateral spondylolysis and left-sided endoscopic decompression. The model of Gill's laminectomy (conventional decompression surgery of the spondylolysis) was also created. ⋯ In the other motions, i. e., extension, lateral bending, or axial rotation, the results were similar among all of the models. These results indicate that the Gill's procedure may lead to an increase in intradiscal pressure (IDP) and other biomechanical parameters after the surgery during flexion, whereas the endoscopic decompression did not change the segment mechanics after the surgery, as compared to the spondylolysis alone case. In conclusion, endoscopic decompression of the spondylolysis, as a minimally invasive surgery, does not alert mechanical stability by itself.
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Minim Invas Neurosur · Apr 2005
Craniocerebral gunshot wounds: results of less aggressive surgery and complications.
Four hundreds patients who suffered from cranial gunshot wounds injuries were analyzed. Surgical therapy, primary and secondary debridement, including repair of dural defects and removal of retained intracranial bone and metal fragments were applied. Central nervous system infections were mostly observed in cases with cerebrospinal fluid (CSF) fistulas. ⋯ Retained fragments did not increase the infection risk but high rates of infection did occur in cases with CSF fistulas. The presence of diffuse brain damage, brainstem injury, CNS infection, or ventricular injury was associated with a poor outcome. The prognostic importance of complications such as intracranial haemorrhage, epileptic seizures, hydrocephalus, was also investigated.
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Minim Invas Neurosur · Apr 2005
Non-traumatic elevation techniques of the hypoglossal nerve during carotid endarterectomy: a cadaveric study.
Ligation and dissection techniques of sternocleidomastoid artery, vein, ansa cervicalis and posterior belly of digastric muscle were developed in a cadaveric study for achieving minimally invasive elevation of the hypoglossal nerve during carotid endarterectomy and were subsequently used in patient treatment. ⋯ Carotid endarterectomy through having knowledge of the normal and variable trajectories of the structures can almost always be accomplished as a safe procedure when appropriate maneuvers are applied. Dissection and ligation of the sternocleidomastoid artery, vein, ansa cervicalis and posterior belly of digastric muscle are very simple but effective techniques to obtain adequate exposure either for safe arterial reconstruction or to diminish the necessity for more complicated technical procedures.