Advances and technical standards in neurosurgery
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Adv Tech Stand Neurosurg · Jan 2014
Navigation, robotics, and intraoperative imaging in spinal surgery.
Spinal navigation is a technique gaining increasing popularity. Different approaches as CT-based or intraoperative imaging-based navigation are available, requiring different methods of patient registration, bearing certain advantages and disadvantages. So far, a large number of studies assessed the accuracy of pedicle screw implantation in the cervical, thoracic, and lumbar spine, elucidating the advantages of image guidance. ⋯ Spinal navigation is closely related to intraoperative 3D imaging providing an imaging dataset for navigational use and the opportunity for immediate intraoperative assessment of final screw position giving the option of immediate screw revision if necessary. Thus, postoperative imaging and a potential revision surgery for screw correction become dispensable. Different concept of spinal robotics as the DaVinci system and SpineAssist are under investigation.
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Adv Tech Stand Neurosurg · Jan 2014
Anaesthesiological and intensive care management in craniovertebral junction surgery.
The main factors of modern perioperative care of the craniovertebral junction surgery include a comprehensive approach to the patients, including a thorough cardiorespiratory, neurophysiological, and metabolic assessment, intraoperative monitoring of spinal cord function, safe airway management, and judicious use of fluids and blood transfusions. Admission in PICU shortly after the CVJ surgery is mandatory to ensure haemodynamic and respiratory stability and to recognize postoperative complications. Anticipating complications in order to achieve an early treatment and adverse event prophylaxis can contribute to reduced morbidity and mortality and increased patients' safety. Multidisciplinary management of perioperative patient care and careful pain control is mandatory in order to improve the outcomes.
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Kyphosis is a difficult topic of spinal surgery, and its management contains many controversies. Surgical management needs consideration of different aspects of the kyphotic deformity such as neurological status, the presence of spinal cord compression, angle of the kyphosis, the quality of bone, and accompanying diseases. In case of significant cord compression and neurological compromise, anterior surgery should have the priority. ⋯ Pedicle subtraction osteotomy is a technically demanding procedure that requires surgeons to perform meticulous technique and consider biomechanical issues to achieve satisfactory results and avoid complications. An attempt to correct the rigid fixed spinal deformity is a difficult task and requires the capability of a highly experienced spine surgeon. Although the physical outcome and patient satisfaction of surgical treatment is quite good, risks and complications should always be considered by both the physician and patient.
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Adv Tech Stand Neurosurg · Jan 2012
ReviewTreatment modalities for intractable epilepsy in hypothalamic hamartoma.
Hypothalamic hamartoma (HH) is usually associated with refractory epilepsy, cognitive impairment, and behavioral disturbance. There is now increasing evidence that HH can be treated effectively with a variety of neurosurgical approaches. ⋯ Two surgical techniques, resection and disconnection, had been described with favorable outcomes. Pretreatment evaluation, patient selection, surgical techniques, complications, and possible selection of treatment are discussed in this chapter.
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Adv Tech Stand Neurosurg · Jan 2012
ReviewCritical review of palliative surgical techniques for intractable epilepsy.
Approximately one third of epilepsy patients are not adequately treatable by antiepileptic medication. Curative resective epilepsy surgery can be performed in only a subgroup of these pharmacoresistent patients in whom the epileptogenic focus is localizable and does not overlap with eloquent brain areas. To the remaining patients (with bilateral or multiple epileptogenic foci, with epilepsy onset in eloquent areas, or with no identifiable epileptogenic focus) palliative epilepsy surgery can be offered if they suffer from disabling seizures. ⋯ There is no general consensus on which palliative procedure is most effective in patients with difficult-to-treat epilepsy syndromes. The decision must be based on individual factors of a given patient. This review summarizes experience with palliative approaches collected in adult and pediatric patient series over the past decades and may help to thoroughly balance beneficial effects and risks of each procedure.