Minimally invasive neurosurgery : MIN
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Minim Invasive Neurosurg · Feb 2010
Case ReportsStaged use of the transsphenoidal approach to resect superior third ventricular craniopharyngiomas.
Craniopharyngiomas are benign tumors, usually originating from the infundibulum or tuber cinereum. Their surgical treatment is challenging because of their relationship to neural and vascular structures. Large craniopharyngiomas that invade the upper third of the third ventricle are a common reason for patients to need a second operation to accomplish a gross total resection. Transsphenoidal approaches are being increasingly used in the treatment of craniopharyngiomas. Large craniopharyngiomas involving the superior third ventricle are most commonly resected through a staged approach, often involving a transcortical or interhemispheric route. ⋯ The authors find this to be an excellent indication for an endoscopic extended transsphenoidal approach in selected cases.
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Minim Invasive Neurosurg · Feb 2010
The true distal posterior inferior cerebellar artery aneurysm: clinical characteristics and strategy for treatment.
A series of aneurysms located at the 4 (th) or 5 (th) segment of the posterior inferior cerebellar artery (PICA) has not been previously reported in the literature. We report six such cases and analyze their clinical characteristics and outcomes from three different treatment strategies. ⋯ Surgery for the true distal PICA aneurysm results in good clinical outcomes. Clipping or wrapping should be considered as the first choice for treatment, and sacrificing the parent artery of the distal PICA aneurysm is relatively safer than selective coiling. The type of parent artery and particularly the collateralization of its distal part should be considered as an essential factor to take into consideration when choosing a treatment strategy.
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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.