World Neurosurg
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Review Case Reports
The Role of Intraoperative Cerebral Angiography in Transorbital Intracranial Penetrating Trauma: A Case Report and Literature Review.
Transorbital intracranial penetrating trauma with a retained intracranial foreign body is a rare event lacking a widely accepted diagnostic and therapeutic algorithm. Intraoperative catheter angiography (IOA) has been advocated by some authorities to rule out cerebrovascular injury before and/or after removal of the object, but no standard of care currently exists. ⋯ In transorbital intracranial penetrating trauma with a retained intracranial object, we advocate microsurgical removal of the object under direct visualization followed immediately by IOA. IOA should be strongly considered even in the setting of minimal intraoperative bleeding and normal findings on videoangiography (a course of action that was not followed in the present case). Given that CT angiography and intraoperative videoangiography may miss a potentially treatable traumatic arterial injury, IOA can help determine whether cerebral revascularization may be necessary.
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Optical neuronavigation without rigid pin fixation of the head may lead to inaccurate results because of the patient's movements during awake surgery. In this study, we report our results using a skull-mounted reference array for optical tracking in patients undergoing awake craniotomy for eloquent gliomas. ⋯ A skull-mounted reference array is a simple and safe method for optical neuronavigation tracking without rigid pin fixation of the patient's head.
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Randomized Controlled Trial
General anesthesia versus local anesthesia in stereotactic biopsies of brain lesions - a prospective randomized study.
Stereotactic biopsy of brain lesions with unknown entities is a common neurosurgical procedure to obtain tumor tissue. Pathologists can then provide an exact diagnosis on which further therapy, such as resection, radiotherapy, or chemotherapy, can be based. These procedures can be performed under local or general anesthesia. In this prospective study, we aim to show whether stress levels are higher for patients who undergo stereotactic biopsy under local or general anesthesia. ⋯ The willingness of patients to undergo randomization in this setting was low (13.3%). Within this highly selective group of patients, there was no significant difference for stress levels in patients who underwent stereotactic biopsy under local anesthesia versus general anesthesia. However, median values indicate a trend for higher stress-level values for patients undergoing local anesthesia.
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Cervical sagittal alignment parameters are essential to plan stages of surgery. The aims of this study were to evaluate the relationship between cervical sagittal alignment parameters and surgical outcomes after anterior cervical arthrodesis; to identify parameters linked to a better outcome; to determine the role of the T1 slope, C7 slope, cervical lordosis, and C2-C7 plumb line; and to describe an innovative method to calculate cervical lordosis. A cohort of 70 patients without cervical kyphosis was included in our retrospective study. We analyzed C7 slope, T1 slope, cervical lordosis, and the C2-C7 sagittal vertical axis (SVA). Clinical postoperative outcomes were evaluated with the Neck Disability Index (NDI) and Visual Analog Scale (VAS) score. ⋯ Sagittal parameters are directly correlated with clinical outcome. If C7 slope increases, higher cervical lordosis is necessary to obtain a good outcome. CL/C7 slope (0.7) multiplied by C7 slope can determine the ideal lordosis.
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This study aimed to assess any correlation between serum levels of homocysteine (Hcy) and markers of cerebral hemodynamics, endothelial dysfunction, and cognition impairment in patients with traumatic brain injury (TBI). ⋯ Hcy has a significant correlation with markers of cerebrovascular, endothelial, and cognition abnormality in TBI patients.