Zentralblatt für Neurochirurgie
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Zentralbl. Neurochir. · Nov 2007
Comparative StudyCranioplasty for large skull defects with PMMA (Polymethylmethacrylate) or Tutoplast processed autogenic bone grafts.
Aim of the study was a comparison of cranioplasty using the Tutoplast technology for autogenic bone processing and conventional polymethylmethacrylate (PMMA) calvarial re- construction. ⋯ Cosmetic results were more satisfactory with Tutoplast processed autografts, and the operating time for unilateral surgery was shorter. Complication rates were similar. Resorption occurred in all children and adolescents, but was rare in adults. Thus, Tutoplast processed autogenic bone grafts can be a reasonable alternative to other methods of cranioplasty in adult patients with large craniotomy defects. Cranioplasty in children and adolescents remains an unsolved problem.
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Zentralbl. Neurochir. · Nov 2007
Morphometric studies of the ligamentum flavum: a correlative microanatomical and MRI study of the lumbar spine.
Foraminal degenerative lumbar stenosis is traditionally considered a result of bony narrowing due to osteophytic appositions on the superior articular process. Clinical experience reveals that significant additional compression of the neural structures is due to degenerative hypertrophy of the adjacent ligamentum flavum. Therefore, microanatomical and neuroradiological investigations were performed to determine the microtopography of this ligament, especially with respect to its lateral extension. ⋯ Measurements from mid-aged cadavers show the extent of the ligamentum flavum including its intra- and extraforaminal parts. Due to this anatomical situation a hypertrophic ligamentum flavum may contribute significantly to nerve root compression at the level of the lateral spinal recess. This has to be kept in mind during surgical decompression, which might be incomplete unless these hypertrophied parts are completely removed.
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Zentralbl. Neurochir. · Aug 2007
A less invasive posterior approach for the management of extended secondary epidural abscess technical note.
Spondylodiscitis is considered to be the main cause of epidural abscess. In this report, the authors present their concept for the management of the extended epidural abscess that occurs in combination with spondylodiscitis. It consists of debridement and fusion for spondylodiscitis together with epidural abscess drainage using a microscopically assisted percutaneous technique. ⋯ The postoperative control MRI demonstrated effective drainage of the extended epidural abscess. Regarding the neurological deficits, 3 patients previously classified as Frankel C showed an improvement to Frankel E within 3 months postoperatively. From these results, it seems that our technique (ventro-dorsal abscess drainage combined with a microscopically assisted percutaneous approach) could be a successful method for the management of the extended epidural abscess associated with spondylodiscitis.
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Zentralbl. Neurochir. · Aug 2007
Debridement and spinal instrumentation as a single-stage procedure in bacterial spondylitis/spondylodiscitis.
The best surgical technique for patients with bacterial spinal infections is still discussed controversially. But recent publications suggest that titanium implants can be used safely in infectious sites in combination with debridement and antibiotic therapy. The purpose of this study is to provide further evidence in support of debridement and instrumentation as a single-stage procedure for spinal infection. ⋯ These findings support the position that debridement and instrumented fusion can be performed as a single-stage procedure without an increase in the recurrence rate or morbidity, compared with the use of autologous bone grafting or staged procedures. Same-stage instrumentation allows early postoperative mobilization of the patient, which is advantageous, especially for an increasingly elderly population and in patients with comorbidities.
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Zentralbl. Neurochir. · May 2007
Efficacy of gamma-knife surgery for treating meningiomas that involve the superior sagittal sinus.
Meningiomas involving the superior sagittal sinus (SSS) are among the most challenging tumors to treat. Authors of some recent series have advocated total removal with SSS reconstruction. However gamma-knife surgery is a reasonable choice for these tumors. ⋯ When a small meningioma involves the SSS and the sinus is patent, the first-line treatment should be radiosurgery. If the tumor is large and the sinus is patent, we recommend gross total resection with no removal of SSS. If postoperative or follow-up MR imaging demonstrates residual tumor or recurrence, gamma-knife surgery should be performed. If a large meningioma has completely obliterated the SSS, our policy is to remove the tumor and all sinus tissue without reconstructing the SSS.