Minimally invasive neurosurgery : MIN
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Minim Invasive Neurosurg · Aug 2010
Comparative StudyIso-C/3-dimensional neuronavigation versus conventional fluoroscopy for minimally invasive pedicle screw placement in lumbar fusion.
Minimally invasive spinal surgery (MISS) has evolved over the past years due to the combination of microsurgery, minimal access strategies and neuronavigation. Percutaneous or mini-open pedicle screw placement is a challenge, especially for surgeons not experienced in the use of biplanar fluoroscopy or stereotactic imaging techniques. The aim of the study was to compare the precision of pedicle screw fixation for lumbar fusion procedures using Iso-C/stereotactic 3D neuronavigation (3D NAV) vs. standard AP/lateral fluoroscopy (2D NAV). ⋯ Utilization of 3D NAV for percutaneous or mini-open lumbar screw placement during the early learning curve for MISS was associated with higher screw accuracy. This study demonstrates that the use of 3D navigation can facilitate the learning curve for MISS.
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Minim Invasive Neurosurg · Aug 2010
Case Reports"Bonnet" bypass to proximal trunk of middle cerebral artery with a radial artery interposition graft: technical note.
Anastomosis of the superficial temporal artery (STA) to the middle cerebral artery (MCA) is useful for treating certain patients with internal carotid artery occlusion or MCA occlusion. However, in the case of common carotid artery (CCA) occlusion, since the blood flow in the STA is insufficient, another artery should be used as the donor artery. The cortical branches of the MCA are usually selected as recipients in the STA-MCA bypass. However, the intracranial vascular filling gradually increases over a few months after conventional cortical MCA bypass grafting, while early or even immediate vascular filling is observed after proximal MCA bypass grafting. This study aims to develop an elongation technique of the contralateral STA to reach the proximal segment of the ipsilateral MCA. ⋯ This novel technique of performing the "bonnet" bypass was effective in treating both CCA and ipsilateral VA occlusion; moreover, this procedure of elongation of the STA can increase candidates of the recipient, and enables one to perform a double bypass to the anterior cerebral artery (ACA) or posterior cerebral artery (PCA).
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Minim Invasive Neurosurg · Aug 2010
Endovascular management in children with vein of Galen aneurysmal malformation.
A vein of Galen aneurysmal malformation (VGAM) is a relatively rare vascular malformation, often resulting in high morbidity and mortality. While surgical arterial clipping has been reported for decades, results in the literature have recently favored endovascular treatment. ⋯ Our purpose in treating a patient with VGAM is to achieve normal brain development using minimally invasive interventions. Our treatment strategies were influenced by each patient's clinical status, their ages, and varying radiographic features. We achieved considerable successful in treating our patients by means of transarterial embolization alone.
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Minim Invasive Neurosurg · Aug 2010
Water jet dissection technique for endoscopic third ventriculostomy minimises the risk of bleeding and neurological complications in obstructive hydrocephalus with a thick and opaque third ventricle floor.
Endoscopic third ventriculostomy (ETV) is a procedure of choice in the treatment of obstructive hydrocephalus. Neurovascular injury while perforating the ventricular floor can occur when using a conventional probe, especially in patients with a thick and opaque third ventricle floor. The water jet dissection technique can be useful in such cases to perform an initial perforation. ⋯ The water jet dissection is a useful technique while performing ETV to prevent neurovascular injury. Our improvised technique of creating a water jet is safe, inexpensive, readily available and can be practiced at any centre performing ETV.
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Minim Invasive Neurosurg · Jun 2010
Percutaneous endoscopic lumbar herniectomy for high-grade down-migrated L4-L5 disc through an L5-S1 interlaminar approach: a technical note.
L4-L5 disc herniations can be treated with percutaneous endoscopic lumbar discectomy (PELD) using a transforaminal posterolateral approach. Although PELD has some distinct advantages over conventional open discectomy, inadequate decompression is a major cause of failure of the procedure, especially with high-grade migrations. The objective of this technical note is to present a new surgical approach for treating high-grade, down-migrated, L4-L5 disc herniations through an L5-S1 interlaminar endoscopic approach. ⋯ This technical note presents a new technique for treating high-grade, down-migrated, L4-L5 disc herniations with PELD using an L5-S1 interlaminar approach.