Minim Invas Neurosur
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Minim Invas Neurosur · Jun 2008
Modified vertebroplasty using a curved probe: technique and preliminary results.
One of the main limitations of vertebroplasty is the excessive pressure required for injection of sufficient cement into a vertebral body. Kyphoplasty can be used to reduce injection pressure by making a void with a balloon tamp. The author presents a technique of making small voids to reduce cement delivery pressure during vertebroplasty that involves a simple modification of the conventional technique. ⋯ The described modification of vertebroplasty involving the creation of small cavities using a curved probe appears to control cement injection easily during the procedures and minimize cement leakage-related complications.
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Minim Invas Neurosur · Jun 2008
The Miethke dual switch valve: experience in 169 adult patients with different kinds of hydrocephalus: an open field study.
In spite of the development of approximately 200 different shunt systems within the last 50 years, overdrainage and valve obstructions are still major problems in the current treatment of hydrocephalus. In 1994, a new gravitational valve with different opening pressures (depending upon the patient's posture) and a big contact area to CSF was introduced by Miethke and co-workers (DSV). We report about a single institution's experience in the treatment of 169 adult patients with different kinds of hydrocephalus with this valve. ⋯ Among the currently available shunt systems, this series is one with the lowest complication rates due to overdrainage and valve obstructions. In patients with NPH, where low opening pressures are essential, the DSV seems to bear an advantage because of a high drainage rate and, in spite of this, a low rate of overdrainage. Even in patients with relatively high CSF protein content, we did not observe any valve obstruction. This study was an open field analysis providing data about the current complication rates of hydrocephalus treatment with this shunt system, outside of a specialized hydrocephalus team or a prospective study trial. However, this study is a retrospective analysis and a prospective randomized controlled trial is required for the comparison of these valves with other shunt systems, such as programmable and flow-controlled ones is required for the future.
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Minim Invas Neurosur · Jun 2008
Case ReportsMinimally invasive surgical closure of a spinal dural arteriovenous fistula.
The treatment of a spinal dural arteriovenous fistula (DAVF) via a minimally invasive approach utilizing a tubular retraction system is described. ⋯ Surgical treatment of spinal DAVFs can be performed in a targeted, minimally invasive manner with a short operative time and minimal tissue disruption.
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Minim Invas Neurosur · Apr 2008
Comparative StudyComparison of techniques for decompressive lumbar laminectomy: the minimally invasive versus the "classic" open approach.
Decompressive laminectomy offers an effective surgical treatment of lumbar spinal stenosis. The purpose of this study was to compare the elements of treatment commonly associated with successful outcomes in the assessment of laminectomies - operating room times, estimated blood loss, length of stay, and complications - of the minimally invasive and open approach laminectomies. ⋯ Bilateral decompression of lumbar spinal stenosis via a unilateral approach involves shorter operating times and less blood loss, less muscle dissection, fewer and less severe complications, and better mobility in the immediate postoperative period than open decompressive techniques. In addition, this technique is very similar to the commonly performed microendoscopic discectomy and is easily mastered over time.
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Minim Invas Neurosur · Apr 2008
Case ReportsIntra-parenchymal tumor biopsy using neuroendoscopy with navigation.
Neuroendoscopy has allowed us to biopsy tumors located in the ventricle and the para-ventricle. With this technique we can obtain specimens under direct visual monitoring and examine tumor dissemination. For intra-parenchymal tumors, however, we normally use stereotactic procedures to collect tissues or perform open biopsies. We now report that we have successfully combined neuroendoscopy with navigational guidance to biopsy intra-parenchymal tumors. We explain our methods and discuss the advantages and disadvantages of this technique. ⋯ We believe that combining neuroendoscopy with navigation guidance is a safe and precise method for obtaining biopsies of intra-parenchymal tumors. Tumors with rich vasculature will not benefit from this procedure until better hemocoagulation instruments have been developed.