Minim Invas Neurosur
-
Minim Invas Neurosur · Aug 2008
Case ReportsEndovascular surgery using stents for vertebral artery dissecting aneurysms and a review of the literature.
The treatment of dissecting aneurysms of the vertebral artery (VA) involving the posterior inferior cerebellar artery (PICA) or presenting with hypoplasia of the contralateral VA is controversial. We describe our experience with 4 ruptured and 2 unruptured VA dissecting aneurysms and discuss the efficacy of endovascular surgery using stents. All patients were male; their mean age was 50.7 years. ⋯ According to the Glasgow Outcome Scale (GOS), at 3 months after treatment 2 patients had made a good recovery, one was moderately disabled, one suffered severe disability, and 2 had died. One death each was due to acute myocardial and brain stem infarction. Endovascular surgery using stents may be a useful treatment in patients in poor condition who manifest dissecting VA aneurysms involving the PICA or hypoplasia of the contralateral VA, especially in the acute period after rupture.
-
Minim Invas Neurosur · Aug 2008
Spinous process splitting laminectomy for lumbar canal stenosis: a critical appraisal.
Spinous process splitting laminectomy (SPSL) is a surgical technique for lumbar canal stenosis, which aims to preserve the paraspinal muscles. Twenty-five patients with lumbar canal stenosis who consecutively underwent SPSL from June 2005 to December 2005 were evaluated. Clinical outcomes were assessed using the visual analogue scale (VAS) scores and Oswestry disability index (ODI). ⋯ However, a significant improvement (> 50% of their initial VAS/ODI score) of back pain, leg pain, and functional status was observed in only 65.2, 65.2, and 52.2%, respectively. Complications occurred in 4 patients (16%). Although SPSL for lumbar canal stenosis yielded relatively good clinical outcomes, the percentage of patients showing significant improvements in back pain, leg pain, and functional status were less than expected at one year after surgery.
-
Minim Invas Neurosur · Aug 2008
Treatment of degenerative cervical disc disease with uncoforaminotomy--intermediate clinical outcome.
Anterior cervical uncoforaminotomy (uncoforaminotomy) is an operative method intended to preserve the functional motion segment of the cervical spine while removing the underlying pathology. Controversy exists concerning the patients best suited for this treatment modality. Furthermore, no long-term outcome analyses have been published. ⋯ Uncoforaminotomy, especially in patients with soft-disc pathologies, is a good operative method for the treatment of radicular pain.
-
Minim Invas Neurosur · Aug 2008
Endoscopic endonasal transsphenoidal surgery using a skull reference array and laser surface scanning.
Lesions of the skull base are increasingly being resected via the endoscopic, endonasal, transphenoidal approach. We have successfully treated 33 consecutive patients with pituitary lesions using this technique in combination with BrainLAB skull reference array and laser surface scanning for surgical navigation. ⋯ This is particularly important as extension and flexion of the head provide greater exposure to the clivus and anterior skull base respectively. Also, this technique obviates the need for additional preoperative MRI, thereby reducing cost and delays.
-
Minim Invas Neurosur · Jun 2008
Low-dose gamma knife radiosurgery for cavernous sinus hemangioma: report of 3 cases and literature review.
Optimal management of cavernous sinus hemangiomas remains unclear. Total microsurgical removal of these neoplasms may be extremely difficult due to their rich vascularization. Three cases of cavernous sinus hemangioma treated with low-dose Gamma Knife radiosurgery are presented. ⋯ In all patients the shrinkage of the neoplasm was accompanied by notable improvement of the preexistent oculomotor nerve palsy. No radiosurgery-related complications were met during follow-up. In conclusion, low-dose Gamma Knife radiosurgery seems to be very effective for management of cavernous sinus hemangiomas, and can be considered as a treatment modality of choice for these lesions.