Minimally invasive neurosurgery : MIN
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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.
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Minim Invasive Neurosurg · Oct 2009
Case ReportsMinimally invasive approaches to treating chemosis of the eyes from unusual dural arteriovenous fistulae.
Chemosis of the eyes is usually attributed to carotid cavernous sinus dural arteriovenous fistulae. Herein, we reviewed unusual cases in which chemosis of the eyes originated from dural ateriovenous fistulae (dAVFs) that were distinctly different from carotid cavernous sinus fistulae. ⋯ Several different types of dural AVFs were associated with chemosis, and these included dAVFs harboring a feeding artery from branches of the external carotid artery directly draining to the superior ophthalmic vein or cavernous sinus via the superior petrous sinus, posterior fossa dAVFs draining via the inferior petrous sinus and cavernous sinus to the ophthalmic vein, a fistula between the ophthalmic artery or branches of the internal carotid artery and inferior ophthalmic vein, or tentorial fistula with a drainage vein to the cavernous sinus via the vein of Galen. This study reviews the symptomatology, treatment options, and cerebrovascular abnormalities observed for these unusual dAVF's with chemosis.
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Minim Invasive Neurosurg · Aug 2009
Comparative StudyProspective comparative study of lumbar sequestrectomy and microdiscectomy.
During microsurgical disc operation, usually a sequestrectomy and a nucleotomy are performed. Whether a nucleotomy is necessary in any case is disputed. The aim of this study is to examine this question on the basis of clinical results and to compare rates of recurrence between the two groups. ⋯ Sequestrectomy alone is a safe operative modality. Sequestrectomy does not seem to entail a higher rate of recurrences compared with microdiscectomy and the results are as favourable as or better than results after discectomy.
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Minim Invasive Neurosurg · Aug 2009
The minimally invasive supraorbital subfrontal key-hole approach for surgical treatment of temporomesial lesions of the dominant hemisphere.
Surgery in the temporomesial region is generally performed using a subtemporal, transtemporal, or pterional-transsylvian approach. However, these approaches may lead to approach-related trauma of the temporal lobe and frontotemporal operculum with subsequent postoperative neurological deficits. Iatrogenic traumatisation is especially significant if surgery is performed in the dominant hemisphere. ⋯ In selected cases, the minimally invasive supraorbital craniotomy offers excellent surgical efficiency in the temporomesial region with no approach-related morbidity compared to a standard transtemporal or pterional-transsylvian approach.