World Neurosurg
-
Comparative Study
Dhaga Technique for Tissue Plane Preservation after Decompressive Craniectomy: Comparison of New Technique with Institutional Standard.
During cranioplasty after decompressive craniectomy, the temporalis muscle is firmly attached to the dural patch and intermixed with fibrotic tissue leading to considerable difficulty in dissecting the plane between the dura, galea and the temporalis muscle. This leads to increased surgical time, intraoperative blood loss, risk of complications and also affects rehabilitation. We have developed the "dhaga technique," which aids in preserving the plane between the muscle and dura in order to improve outcomes. Here we describe our technique and also compare the "dhaga technique" with the generally accepted standard procedure. ⋯ The utilization of "dhaga technique" can potentially improve outcomes and reduce costs by decreasing operative time and blood loss. Moreover, the temporalis muscle preservation in the "dhaga technique" may also enhance aesthetic outcomes and chewing, which were not assessed in this study. There were no differences in complication between the two techniques.
-
Case Reports
Aneurysm Clip Compression Technique in the Surgery of Aneurysms with Hard/Calcified Neck.
One of the most important technical problems in surgery to repair aneurysms is the presence of a hard/calcified neck. In this situation, various techniques can be used for proper clipping. In addition to well-known techniques, we have used a different technique for more than 10 years. This technique probably also has been used by other neurosurgeons, but we could not find any publications about it in the English literature. Therefore, we would like to report the details of this technique and our own experience. ⋯ Our aneurysm clip compression technique may be a viable option in surgery of aneurysms with hard-calcified neck.
-
To evaluate the role of neoadjuvant chemotherapy and radiotherapy in the treatment of central nervous system germinomas in 38 patients who received definitive treatment and were followed-up >5 years between 1980 and 2009. ⋯ Chemotherapy followed by whole ventricle radiotherapy, with or without local boost, and with use of neuroendoscopy results in good disease control without late complications in patients with germinomas.
-
Lumbar fusion is a widely used procedure for degenerative spine diseases but frequently is accompanied with substantial surgical blood loss. We aimed to investigate the risk factors for significant intraoperative blood loss and the influence of excessive bleeding on postoperative complications in patients undergoing fusion for degenerative lumbar spines. ⋯ Because substantial bleeding in lumbar fusion is associated with a greater incidence of morbidities and prolonged length of hospital stay, attention to the risk factors for significant blood loss is important in the preoperative assessment and postoperative guidance for the level of care.
-
Case Reports
A Single-Center Experience with the NeuroPace RNS System: A Review of Techniques and Potential Problems.
The clinical results for the RNS System (NeuroPace, Mountain View, California, USA) closed-loop responsive neurostimulator for the treatment of medically intractable partial-onset seizures have been encouraging. The University of Southern California (USC) Neurorestoration Center and the Keck Hospital of USC have become the world's first institutions to implant an RNS System post U.S. Food and Drug Administration (FDA) approval. As one of the study centers, we review our experience with our group of patients who have been implanted with the RNS System. ⋯ Our experience with the NeuroPace RNS System over an average follow-up of 45 months suggests that the surgery and device are safe when placed by an experienced surgeon. Although there were no clinically significant hematomas or patient deaths, we did have 1 patient each with infection and lead damage at the point of exit from the skull. We compare the results of this study with other neuromodulation procedures for epilepsy to evaluate the safety and complications associated with the RNS System. Our initial experience suggests that the RNS System can be readily incorporated into an active epilepsy surgical center.