Minim Invas Neurosur
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The purpose of this study was to describe the usefulness of recent advances of neuronavigational technology in the management of skull base tumors and of vascular lesions, treated via a skull base approach. ⋯ The authors' experiences suggest that neuronavigation, which displays 3-dimensional reconstructions of lesion, vessels, nerves and fiber tracts during surgery and makes use of image fusion techniques, is an important tool in the neurosurgical management of skull base lesions.
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Minim Invas Neurosur · Dec 2004
Case ReportsSubthalamic nucleus stimulation for advanced Parkinson's disease: how to find a far medial STN.
In a patient with advanced Parkinson's disease, an anatomically deviant far medial subthalamic nucleus (STN) posed problems in the placement of DBS electrodes for chronic high frequency (HF) stimulation despite the use of multimodal targeting with 1) statistical atlas data, 2) T (2)-weighted (T (2)W) magnetic resonance imaging (MRI), 3) microelectrode recording, and 4) clinical testing with macro stimulation. Diagnostic T (2)W MRI suggested that the patient's STN was in a typical location and seemed to confirm the statistical atlas-based planning. Intraoperatively, cell activity recording (MER) with five parallel electrodes could not reveal any STN typical activity profile and electrical stimulation was not able to disclose a medial or lateral displacement of the electrodes. ⋯ Postoperative T (2)W MRI now disclosed a left STN which was 2 mm medial of the initial target and lead to a further medial target definition and finally to a successful DBS placement. In conclusion, finding a deep seated DBS target like the STN can be difficult in cases with an extremely deviant anatomy even if reiterative sophisticated multimodal planning is used. In the presented case we applied the integrated information from intraoperative MER, macrostimulation and postoperative imaging work-up and were able to complete DBS implantation successfully.
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Minim Invas Neurosur · Dec 2004
Surgical anatomy and efficient modification of procedures for selective extradural anterior clinoidectomy.
The surgical anatomy of structures surrounding the anterior clinoid process (ACP) was examined in 39 cadavers to enable safe performance of selective extradural anterior clinoidectomy. ⋯ We propose a modified, efficient procedure for selective extradural anterior clinoidectomy, as follows. Drilling is started from the point approximately 9 mm posterior to the lateral margin of the dural insertion into the SOP, and pointed medially in the direction with a right angle to the lateral margin of the ACP. After drilling about 6 mm to reach the lateral border of the OC, unroofing of the OC is carried out to remove the ACP en bloc by fracturing of the optic strut. Using the present procedure, the distance of drilling of the lesser wing of the sphenoid bone is minimized.
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Minim Invas Neurosur · Oct 2004
Comparative StudyImpact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas: a single-institution retrospective study.
Neuronavigation has become an effective therapeutic modality and is used routinely for intra-axial tumor removal. This retrospective study was conducted to evaluate the clinical impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas. Between 1990 and 2002, 76 adult patients with pathologically confirmed malignant astrocytomas underwent craniotomy and removal of the tumors at the Toyama Medical and Pharmaceutical University Hospital. ⋯ The percentage of a gross total resection was significantly higher in the neuronavigation group compared to that in the no-navigation group (64.3 % vs. 38.2 %, p < 0.05). Neurological deterioration occurred in 4 of 42 (9.5 %) and in 6 of 34 (17.6 %) patients after surgery with neuronavigation and surgery without neuronavigation, respectively, although this difference was not statistically significant. Our results showed that neuronavigation increases the radicality in the resection of malignant astrocytomas and is objectively useful for improving survival time.
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Minim Invas Neurosur · Oct 2004
Preoperative embolization of intracranial meningiomas with Embosphere microspheres.
To reduce intraoperative bleeding and to facilitate surgery by inducing tumor softening, a preoperative embolization of meningiomas is commonly recommended. ⋯ Our experiences show that Embosphere microspheres are effective embolic agents in obstructing meningeal feeders of preoperatively treated meningiomas.