Minimally invasive neurosurgery : MIN
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Minim Invasive Neurosurg · Oct 2009
Microsurgical treatment for typical pituitary apoplexy with 44 patients, according to two pathological stages.
The aim of this study was to explore the pathogenesis of typical pituitary apoplexy in different periods, to help to formulate a reasonable treatment program and to select the correct operation time. ⋯ Typical pituitary apoplexy is mainly caused by hemorrhage secondary to necrosis after infarction. The staging of this disease provides an important guidance value to diagnosis and treatment. The surgical outcomes in the late stage were significantly better than those in the early stage. The patients without significant symptoms can be conservatively treated by hormone substitution therapy.
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Minim Invasive Neurosurg · Oct 2009
Case ReportsThe combined supraorbital keyhole-endoscopic endonasal transsphenoidal approach to sellar, perisellar and frontal skull base tumors: surgical technique.
Extended endoscopic endonasal transsphenoidal approaches (extended EETA) are increasingly being explored for lesions around the sella and the frontal skull base. These approaches, however, require significant surgical expertise and training that can only be obtained in high-volume centers and therefore these approaches are not generalizable to the whole neurosurgical community. Also, these approaches require significant skull base destruction and reconstruction, which comes with a high risk of CSF fistulas. The aim of this article is to describe a combined supraorbital keyhole-endoscopic endonasal transsphenoidal approach as an alternative surgical strategy to the extended EETA that is easier to perform and that leaves the skull base anatomy more intact. ⋯ The combined supraorbital keyhole-EETA approach can be used without extra surgical training or expertise and with preservation of skull base anatomy for sellar, perisellar and frontal skull base tumors.
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Minim Invasive Neurosurg · Oct 2009
Comparative StudyEffectiveness, security and height restoration on fresh compression fractures--a comparative prospective study of vertebroplasty and kyphoplasty.
Painful fractures of the spine pose a serious clinical problem which gains in importance with the increasing ageing of our population. When conservative treatment of these fractures fails, with vertebroplasty and kyphoplasty we have two percutaneous minimally invasive stabilising procedures at our disposal. ⋯ This study compares vertebroplasty and kyphoplasty with regard to their effectiveness, safety, and restoration of vertebral body height, and complications. There were no differences between the groups with regard to quality of life and pain improvement, but the rate of serious complications was higher after vertebroplasty. Mean vertebral body height restoration at 1 year follow-up was significantly higher (p<0.05) in the kyphoplasty group. It remains to be seen in future long-term studies whether or not restoration of vertebral body height has an effect on the clinical result.
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Minim Invasive Neurosurg · Oct 2009
Risk factors for regrowth of intracranial meningiomas after gamma knife radiosurgery: importance of the histopathological grade and MIB-1 index.
The influence of histopathological grade and MIB-1 index of intracranial meningioma on the results of its radiosurgical management is not clear. The objective of the present retrospective study was to make an evaluation of these factors along with an analysis of other variables associated with progression-free survival after gamma knife radiosurgery (GKR). ⋯ Radiosurgery is a highly effective management option for benign intracranial meningiomas, but growth control of non-benign ones is significantly worse. It requires close neuroradiological follow-up and necessitates the search for modified treatment strategies.
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Minim Invasive Neurosurg · Oct 2009
Endoscopic tracking of a ventricular catheter for entry into the lateral ventricle: technical note.
Tapping the ventricle with a cannula prior to introducing the endoscope is the preferred technique by many neurosurgeons in gaining ventricular access during endoscopic procedures. We have adapted this technique by passing a soft ventricular catheter into the ventricle (instead of a cannula), subsequently following this catheter into the lateral ventricle with the endoscope. Access to the lateral ventricle is planned according to trajectories selected from preoperative imaging and anatomic landmarks with or without the use of stereotactic navigation. The endoscope is introduced along the catheter tract with constant and direct visualization of the shaft of the catheter. ⋯ This technique was used with and without stereotactic navigation and deemed useful in both circumstances as cerebral spinal fluid (CSF) egress through the catheter verifies positioning before the introduction of a larger diameter endoscope. Moreover, once CSF is obtained, the catheter is not removed from this position so no additional error is incurred when the endoscope or rigid plastic sheath is placed. Finally, the catheter serves as a continuous marker to the ventricle allowing repeated endoscopic entries. This technique was found to be particularly useful in biportal procedures to mark specific trajectories that could be easily re-accessed in situations where intraoperative shift occurs.