Acta neurochirurgica. Supplement
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The main goal of improving pain and neurological deficit in the practice of spine surgery is changing for a more ambitious goal, namely to improve the overall quality of life and the future of patients through three major actions (1) preserving the vertebral anatomical structures; (2) preserving the paravertebral anatomical structures; and (3) preserving the functionality of the segment. Thus, three new concepts have emerged (a) minimal surgery; (b) minimal access surgery; and (c) motion preservation surgery. These concepts are covered in a new term, minimally invasive spine surgery (MISS) The term "MISS" is not about one or several particular surgical techniques, but a new way of thinking, a new philosophy. ⋯ In most cases, the only evidence one can find in the literature is the lack of evidence (Resnick D (2007) Spine 32:S15-S19.), however, the lack of evidence does not mean its absence. Only then, with a rigorous self-analysis, we may take a clear path towards a new philosophy in spine surgery. Of course, feedback from patients through satisfaction and clinical scales can guide our direction and provide the energy needed to maintain the enthusiasm (Fig. 12).
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Acta Neurochir. Suppl. · Jan 2011
Percutaneous coblation nucleoplasty in patients with contained lumbar disc prolapse: 1 year follow-up in a prospective case series.
Nucleoplasty appears a successful minimally-invasive treatment for symptomatic contained disc herniation (protrusion). The purpose of this prospective study was to assess the effectiveness of nucleoplasty for alleviating pain and dysfunction in our patients. ⋯ This disc decompression procedure was a safe and effective treatment option for carefully selected patients affected by low back and leg pain due to contained disc herniation.
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Acta Neurochir. Suppl. · Jan 2011
Case ReportsEndoscopic surgical treatment for pituitary apoplexy in three elderly patients over the age of 80.
As the population continues to live longer, the diagnosis of pituitary adenoma-induced apoplexy becomes more common in the elderly. The standard treatment options for pituitary apoplexy are debatable. Although there is little information regarding the treatment of pituitary apoplexy in elderly patients, the optimal treatment needs to be determined for this age group. The current study examined the surgical treatment of pituitary apoplexy in three patients over the age of 80. ⋯ Endoscopic transsphenoidal surgery has the advantage of visualization of the structures surrounding the pituitary gland. Moreover, the complication rate is relatively low because stress on the pituitary gland can be reduced by using this procedure. Even in patients over 80 years of age during the subacute phase, endoscopic surgical management is a good treatment candidate for pituitary apoplexy with mass lesion extension into the cavernous sinus.
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Acta Neurochir. Suppl. · Jan 2011
Treatment of discogenic low back pain with Intradiscal Electrothermal Therapy (IDET): 24 months follow-up in 50 consecutive patients.
Degeneration of the intervertebral disc can be the source of severe low back pain. Intradiscal electrothermal therapy (IDET) is a minimally invasive treatment option for patients with symptomatic internal disc disruption nonresponsive to conservative medical care. ⋯ The findings of this study suggest that durable clinical improvements can be realized after IDET in highly selected patients with mild disc degeneration, confirmatory imaging evidence of annular disruption and concordant pain provocation by low pressure discography.
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Acta Neurochir. Suppl. · Jan 2011
Neuromonitoring in intensive care: a new brain tissue probe for combined monitoring of intracranial pressure (ICP) cerebral blood flow (CBF) and oxygenation.
the benefits of monitoring cerebral blood flow (CBF) in stroke patients are apparent. New techniques combining near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution to estimate cerebral hemodynamics are available. However, with transcutaneous NIRS and optodes applied over the skin, the signal is contaminated by extracerebral tissues. The objective is to develop a new brain tissue probe for combined monitoring of intracranial pressure (ICP), CBF and cerebral blood volume (CBV). ⋯ NIR spectroscopy allows the synchronous determination of multiple parameters with one single device. By measurements in parallel with the NeMo Probe and NIRS optodes placed over the skin, new algorithms can be developed to subtract the extracerebral contamination from the NIRS signal.