World Neurosurg
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External ventricular drains (EVDs) historically have a high rate of infection, and EVD infections are a cause of significant morbidity and mortality. We have shown previously that a simple infection control protocol reduced the rate of EVD infections during a 3-year period, and the present study examines whether infection rates were durably reduced over an additional 4 years. ⋯ A straightforward EVD infection control protocol substantially and durably reduces EVD infections to a near-zero rate.
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Case Reports
Improvement of Table Tennis Dystonia by Stereotactic Ventro-oral Thalamotomy: A Case Report.
Task-specific focal dystonia, such as writer's cramp and musician's cramp, is a type of dystonia that affects performance of particular tasks. Such movement disorders have been treated with stereotactic ventro-oral (Vo) thalamotomy with excellent outcomes. However, there has been no previous report of treatment of sport-related or athlete's dystonia by means of stereotactic surgery. We treated a patient with table tennis-related dystonia with Vo thalamotomy, and evaluated the outcome. ⋯ We applied Vo thalamotomy for the successful treatment of athlete's dystonia, suggesting that this condition has an underlying mechanism similar to that of other task-specific focal dystonias. This provides new hope to patients with athlete's dystonia refractive to other therapies.
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Microsurgical treatment for vertebral artery aneurysms can be approached through the lateral aspect of the brainstem and cerebellum. A contralateral approach may be selected in complex aneurysms with tortuous running and the intracranial vertebral artery distal to the aneurysm located in the contralateral cerebellopontine angle. When repairing the aneurysm, exposing the V3 segment before craniotomy is advantageous. We describe the detailed surgical procedures of the contralateral transcondylar fossa approach with bilateral V3 segment exposure for the repair of a complex vertebral artery aneurysm. ⋯ The contralateral transcondylar fossa approach with bilateral V3 exposure is feasible for the repair of complex vertebral artery aneurysms showing a deviated and difficult to access V4 segment proximal to the aneurysm. Bilateral V3 exposure may also facilitate aneurysm bypass procedures such as those using a V3-V4 anastomosis.
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Complex aneurysms of the anterior cerebral artery (ACA) may require a bypass procedure as part of their surgical management. Most current bypass paradigms recommend technically demanding side-to-side anastomosis of pericallosal arteries or use of interposition grafts, which involve longer ischemia times. The purpose of this study is to assess the feasibility of an anterior temporal artery (ATA) to ACA end-to-side bypass. ⋯ ATA-ACA bypass is anatomically feasible and may be a useful alternative to other revascularization techniques in selected patients. It is technically simpler than A3-A3 in situ bypass. ATA-ACA bypass can be performed through the same pterional exposure used for the ACA aneurysms, sparing the patient an additional interhemispheric approach, required for the A3-A3 anastomosis.
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To analyze the safety and feasibility of laparoscopic-assisted ventriculoperitoneal shunt (VPS) insertion in children younger than the age of 1 year and weighing less than 5 kg. ⋯ Laparoscopic-assisted VPS insertion in children seems to be safe and feasible leading to very good results even in patients under the age of 1 and weighing less than 5 kg.