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
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
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 · 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
Case ReportsNeuronavigation in the minimally invasive presacral approach for lumbosacral fusion.
Intraoperative 3D navigation (3D NAV) is gaining importance in spinal surgery, especially with the advancement of minimally invasive techniques in this field. We hypothesized that 3D NAV may be of benefit in the recently described minimally invasive presacral approach for L4-S1 fusion (AxiaLIF). ⋯ The minimally invasive presacral approach to L4-L5-S1 fusion can be performed safely and accurately with intraoperative 3D NAV. This is especially the case in two-level AxiaLIF procedures, where computer guidance can provide better planning possibilities for optimal screw trajectory.