Acta neurochirurgica. Supplement
-
Acta Neurochir. Suppl. · Jan 2005
Case ReportsSurgical intradiscal decompression without annulotomy in lumbar disc herniation using a coblation device: preliminary results.
Annulotomy is a mandatory step to perform intradiscal decompression to resolve a disco radicular conflict. However, this manoeuvre can lead to post surgical complications such as vertebral instability and back pain. Coblation assisted microdiscectomy (CAM procedure) allows a quoted removal of disc without anulus damage.
-
Acta Neurochir. Suppl. · Jan 2005
Cranial and spinal dural arteriovenous malformations and fistulas: an update.
Awareness of a potential arteriovenous fistula is critical for diagnosis of cranial as well as spinal fistulas. The natural history of cranial and spinal dural arteriovenous fistulas has been clarified during the last decade and interdisciplinary therapies have experienced a substantial development recently. The classification of Cognard & Merland is now the most widely accepted one for cranial dural AVF. ⋯ The risk associated with surgical or endovascular treatment of benign fistulas is higher than the risk of eliminating fistulas that have already led to cortical venous reflux. Transvenous endovascular occlusion or surgical disconnection of draining veins is the treatment of first choice for cranial and spinal dAVF with venous flow reversal. Benign cranial dural arteriovenous fistulas are a developing indication for radiosurgery.
-
Acta Neurochir. Suppl. · Jan 2005
Clinical TrialSurgical radio-frequency epiduroscopy technique (R-ResAblator) and FBSS treatment: preliminary evaluations.
Failed back surgery syndrome represents a heterogeneous situation that suggests a fibrosis or neuroinflammatory genesis. The social cost related to this issue are enormous. Several surgical techniques have been applied to FBSS patients with controversial effectiveness. In 1998 we evaluated the efficiency and limits of epiduroscopy treatment; it proved to be effective in 75% of cases, but in 45% of cases it needed to be repeated after 12 months. Therefore we subjected 14 patients, who had previously experienced a short temporary benefit by using a traditional epiduroscopic approach, to a new epiduroscopy fibrolysis using a radio-frequency device named "R-Resablator Epiduroscopy". Clinical evaluation was performed before myeloscopy and after 1-3-6 months. After myeloscopy, 93% of patients reported a general improvement. Among the latter, pain was reduced by 90% in 8 patients, by 60-70% in 5, and by less than 30% in 1. ⋯ It can be concluded that RF-Epiduroscopy offers greater therapeutic benefit than traditional epiduroscopy or other surgical techniques. Furthermore, RF-Epiduroscopy is more easily performed and repeated.
-
Acta Neurochir. Suppl. · Jan 2005
Clinical TrialDecompressive craniectomy in severe cerebral venous and dural sinus thrombosis.
To evaluate the outcome of patients with most severe cerebral venous and dural sinus thrombosis (CVT) after decompressive craniectomy. Indications and techniques for decompressive craniectomy and intensive care regimen are discussed. ⋯ Favorable functional outcome in selected patients with most severe courses of CVT can be achieved after decompressive craniectomy. Postoperative anticoagulation therapy with full dose heparin 24 hours after craniotomy seems to be safe. Precise indications and techniques for combined surgical decompression and thrombectomy deserve to be evaluated in future studies.
-
Acta Neurochir. Suppl. · Jan 2005
Accurate data collection for head injury monitoring studies: a data validation methodology.
BrainIT is a multi centre, European project, to collect high quality continuous data from severely head injured patients using a previously defined [6] core data set. This includes minute-by-minute physiological data and simultaneous treatment and management information. It is crucial that the data is correctly collected and validated. ⋯ Advances in patient care require an improved evidence base. For accurate, consistent and repeatable data collection, robust mechanisms are required which should enhance the reliability of clinical trials, assessment of management protocols and equipment evaluations.