World Neurosurg
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To report experience with 7 cases of intracranial aneurysms of the vertebral artery (VA) and its branches that were treated with occipital artery (OA)-posterior inferior cerebellar artery (PICA) bypass. ⋯ OA-PICA bypass with obliteration of the aneurysm is one of the optimal treatments for intracranial aneurysms that occur at the VA and its branches because it can preserve the perforators and distal blood flow from the PICA.
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Historical Article
Scythian trepanations in the Gorny Altai in Hippocratic times: modern expert appraisal of ancient surgical technologies.
To report the analysis of 3 cases of ancient trepanation discovered in the craniological collection (153 skulls) of the Pazyryk nomadic culture (500-300 bc) from the Gorny Altai, Russia, and to evaluate the technique, instrumentation, and materials used for cranial surgery as well as the motivation for the trepanations in Scythian times. ⋯ Our data suggest that the Scythian population of the Altai Mountains had sufficient medical knowledge to perform sophisticated and successful manipulations on the human skulls. Scraping technique with bronze tools was quite effective for prevention of wound infection and resulted in a high survival rate after surgery. In the era of methicillin-resistant Staphylococcus aureus, it may be useful to consider some ancient surgical technologies.
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Observational Study
Risk profile in extracranial/intracranial bypass surgery--the role of antiplatelet agents, disease pathology, and surgical technique in 168 direct revascularization procedures.
Cerebral revascularization procedures are a treatment option in moyamoya disease patients, but recent studies failed to show an immediate benefit in cerebrovascular atherosclerotic disease. To facilitate optimal efficacy of the procedure, a detailed characterization of a representative perioperative complication rate and the role of potential risk factors such as underlying pathology, antiplatelet therapy, and the type of surgery performed is warranted and the purpose of this study. ⋯ Extra-/intracranial bypass surgery remains a treatment option in patients with moyamoya disease, although its use in the context of atherosclerotic disease was recently put into question. Regardless, a detailed characterization of perioperative risk factors is needed to optimize a potential long-term benefit of surgery. At a high-volume center, the complication rate is low independent from the underlying pathology with a high patency rate. Antiplatelet treatment does not increase the risk of hemorrhagic complications, but may improve outcome. Longer follow-up is required to adequately assess the true efficacy of revascularization on stroke prevention.
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Traditionally, lumbar discectomy has involved overnight hospital admission. Recent literature supports the shift to same-day lumbar discectomy because of improved outcomes and better patient satisfaction scores. A successful protocol for outpatient lumbar discectomies was proposed and implemented at a single institution. The aim of this study is to perform a quantitative and qualitative analysis of this institutional model. ⋯ Our data demonstrate that a collaborative protocol for outpatient discectomy can be implemented in a safe and effective manner despite a statistical increase in hospital readmissions. The percentage rates of readmissions and ED visits accounted for a very small percentage of the overall number of cases after protocol implementation. Improvements in perioperative pain management and ensuring that outpatient lumbar discectomies are scheduled early in the day may further decrease the number of admissions. Future studies should examine the societal and financial impact of same-day discectomy versus overnight hospital stays.
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To evaluate the efficiency and safety of a unilateral approach for bilateral foramen decompression in minimally invasive transforaminal lumbar interbody fusion (miTLIF) for the treatment of bilateral foraminal stenosis. ⋯ A unilateral approach for bilateral foramen decompression in miTLIF provides a safe and efficient method for the treatment of bilateral foramen stenosis in patients with degenerative spinal disorders.