Minim Invas Neurosur
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Minim Invas Neurosur · Apr 2008
Case ReportsCombined subtemporal and retrosigmoid keyhole approach for extensive petroclival meningiomas surgery: report of experience with 7 cases.
The resection of petroclival meningiomas offers great challenges to the neurosurgeon. Surgery via a combined subtemporal and retrosigmoid keyhole approach surgery was evaluated for the treatment of extensive petroclival meningiomas on the basis of our experience with 7 cases. ⋯ This combined keyhole approach is suitable for the treatment of extensive petroclival meningiomas. It provides easy and quick access to the supra- and infratentorial juxta-clival regions without any petrous bone drilling. Complications related to the approach can be minimized.
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Minim Invas Neurosur · Feb 2008
Case ReportsExclusive endoscopic removal of a planum sphenoidale meningioma: a case report.
Midline suprasellar meningiomas have traditionally been removed through transcranial approaches. Endoscopic endonasal approaches have already been described for the removal of tuberculum sellae meningiomas (Cook), but their exclusive use for planum sphenoidale meningiomas has never been reported. ⋯ The anterior skull base defect has been reconstructed with a pedicled mucosa flap from nasal septum (Hadad-Bassagasteguy flap). The postoperative course was uneventful, and no sign of recurrence was noticed at the MRI control performed after 3 months.
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Minim Invas Neurosur · Feb 2008
Automated registration of intraoperative CT image data for navigated skull base surgery.
With a new intraoperative computed tomography (CT) imaging system, patient-to-image registration without any invasive registration markers is possible. Furthermore, registration can be performed fully automatically. The accuracy of this method for skull base surgery was investigated in this study. ⋯ Fully automated registration based on a tracked CT gantry is a robust and accurate registration method for skull base surgery.
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Minim Invas Neurosur · Feb 2008
Treatment strategies and outcome in patients with non-tuberculous spinal epidural abscess--a review of 46 cases.
Spinal epidural abscess (SEA) is a rare disease and its early detection and appropriate treatment is essential to prevent high morbidity and mortality. There are only few single-institution series who report their experiences with the microsurgical management of SEA and treatment strategies are discussed controversially. Within the last 15 years the authors have treated 46 patients with SEA. This comparatively high number of cases encouraged us to review our experiences with SEA focussing on the clinical presentation, microsurgical management and outcome. ⋯ Early diagnosis, microsurgical therapy with appropriate antibiotic therapy and careful observation of patients are the keys to successful management of SEA. The goal of surgical treatment is to isolate the causative organism and to perform a decompression at the site of maximal cord compression in cases of neurological deterioration or severe pain. Instrumentation with primary fixation does not seem to be imperative. In cases of post-operative worsening, a fracture of additionally infected bony elements has to be considered and a stabilisation should be discussed on an individual basis.
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Minim Invas Neurosur · Feb 2008
Comparative StudyOpen versus minimally invasive lumbar microdiscectomy: comparison of operative times, length of hospital stay, narcotic use and complications.
To determine if a minimally invasive approach to lumbar microdiscectomy reduces post-operative pain, length of hospital stay, or frequency of complications we retrospectively compared medical records of single level microdiscectomy patients by a single surgeon performed using a traditional open approach versus a minimally invasive approach. Thirty-five patients were in the open group: 63% male, average age 41.2 years, and 31 patients were in the minimally invasive group: 68% male, average age 42.1 years. There was no difference in surgical time or blood loss between the open and minimally invasive groups: 84.1 versus 76.8 minutes and 51.4 versus 69.7 mL, respectively. ⋯ The open group took an average of 11.7 mg oxycodone, the minimally invasive none. 45.2% of patients in the minimally invasive group were discharged on the same day as surgery compared to 5.75% in the open group (P=0.001). Microdiscectomy was performed safely and effectively through a minimally invasive expanding retractor system and operating microscope. Surgical times, blood loss, complications, and outcome were similar to a traditional open microdiscectomy while pain medication requirements and hospitalization were significantly less.