MedWorm: Craniotomy

Anterolateral Mini Fronto-Orbito-Zygomatic Craniotomy via an Eyebrow Incision in Pediatrics: Technical Notes and Evaluation

Karger Publishers — Thu, 02 Feb 2012 12:48:14 +0100

Pediatr Neurosurg (DOI:10.1159/000335399) (Source: Karger Publishers)

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Inhibition and eradication of human glioma with tumor-targeting Salmonella typhimurium in an orthotopic nude-mouse model.

Cell Cycle — Mon, 30 Jan 2012 08:36:30 +0100

In this study, we demonstrated that the Salmonella typhimurium A1-R tumor-targeting strain can inhibit and eradicate human glioma in an orthotopic nude-mouse model. S. typhimurium A1-R was administered by injection through a craniotomy open-window or intravenously in nude mice. To establish the model, 2 x 105 U87-RFP human glioma cells were injected stereotactically into the mouse brain through the craniotomy open window. Two weeks after glioma-cell implantation, mice were treated with S. typhimurium A1-R [2 x 10 ( 7) CFU/200 μl intravenous injection (i.v.) or 1 x 10 ( 6) CFU/1 μl intracranial injection (i.c.)] once a week for 3 weeks. Brain tumors were observed by fluorescence imaging through the craniotomy open window over time. S. typhimurium A1-R, administered i.c., inhibited brain t...

Does ventricular opening promote remote cerebellar haemorrhage?

Turkish Neurosurgery — Mon, 30 Jan 2012 05:00:02 +0100

Authors: Ziyal I, Bilginer B, Yavuz K, Turk C, Ozgur C, Benli K Abstract Cerebellar haemorrhage after supratentorial craniotomy is a rare complication Because of its significant morbidity and mortality rates, being aware of this complication is important for early diagnosis. In a 30-year-old male with multiple intracranial cavernomas, remote cerebellar haemorrhage (RCH) was observed after removal of symptomatic left temporal lesion. The lateral wall of the temporal horn that was tightly attached to the cavernoma was also opened and excessive drainage of the CSF occurred. The haemorrhage is attributed to opening of the ventricle wall and excessive drainage of cerebrospinal fluid (CSF) during the procedure. PMID: 22274980 [PubMed - in process] (Source: Turkish Neu...

Supraorbital Keyhole Approach to Upper Basilar Artery Aneurysms via the Optico-Carotid Window: A Cadaveric Anatomic Study and Preliminary Application

min - Minimally Invasive Neurosurgery — Wed, 25 Jan 2012 05:00:00 +0100

Minim Invasive Neurosurg 2011; 54: 228-235DOI: 10.1055/s-0031-1287833No anatomic data are available addressing the surgical indication for upper BA aneurysms via the supraorbital keyhole approach (SOKA).An anatomic study of the SOKA to the upper BA via the optico-carotid window (OCW) was designed. Our clinical experience is reported.After completing the SOKA craniotomy on 8 cadaveric heads, the width and length of OCW and the length of the supraclinoid internal carotid artery (SCICA) were measured. Measurement of the following was carried out through the OCW: (i) linear distance (a) of the BA from the most proximal point of visualization of the BA to the posterior clinoid process level, (ii) perpendicular distance (b) from the most distal point of visualization along the elongation of the ...

Individualized Pterional Keyhole Clipping Surgery based on a Preoperative Three-Dimensional Virtual Osteotomy Technique for Unruptured Middle Cerebral Artery Aneurysm

min - Minimally Invasive Neurosurgery — Wed, 25 Jan 2012 05:00:00 +0100

Minim Invasive Neurosurg 2011; 54: 207-213DOI: 10.1055/s-0031-1286335Individualized surgical simulation using three-dimensional (3D) imaging to allow safe performance of clipping surgery for unruptured middle cerebral artery (MCA) aneurysm via pterional keyhole mini-craniotomy was performed in 100 consecutive patients.3D images were reconstructed of the skin, skull, cerebral arteries and veins, and aneurysm. The size, shape, and location of the scheduled keyhole and the patient’s head position were individually optimized using this preoperative simulation system. The site of opening of the sylvian fissure was also preoperatively determined according to the spatial relationships between the aneurysm and sylvian veins. 110 pterional keyhole clipping surgeries were consecutively performed i...

Skull Bone Flap Fixation – Reliability and Efficacy of a New Grip-Like Titanium Device (Skull Grip) versus Traditional Sutures: A Clinical Randomized Trial

min - Minimally Invasive Neurosurgery — Wed, 25 Jan 2012 05:00:00 +0100

Minim Invasive Neurosurg 2011; 54: 282-285DOI: 10.1055/s-0031-1297246After completing a craniotomy, it is important to replace the removed bone flap in its natural position in order to guarantee brain protection as well as improve cosmesis. A skull defect can expose the brain to accidental damage, and in cases of larger defects it may also cause the patients psychosocial problems. The ideal fixation device should provide reliable attachment of the flap to the skull and promote fast bony healing to avoid possible pseudo-arthrosis and/or osteolytic changes.This is a pilot randomized clinical trial on a series of 16 patients undergoing different craniotomies for benign brain lesions in which the bone flaps were replaced using traditional sutures (Prolene 0.0) in 8 cases and with a new skull f...

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Trans-Lamina Terminalis Approach to Third Ventricle using Supraorbital Craniotomy: Technique Description and Literature Review for Outcome Comparison with Anterior, Lateral and Trans-Sphenoidal Corridors

min - Minimally Invasive Neurosurgery — Wed, 25 Jan 2012 05:00:00 +0100

Minim Invasive Neurosurg 2011; 54: 236-242DOI: 10.1055/s-0031-1297996The trans-lamina terminalis approach has been described to remove third ventricular tumors. Various surgical corridors for this approach include anterior (via bifrontal craniotomy), anterolateral (via supra-orbital craniotomy), lateral (via pterional craniotomy) and trans-sphenoidal corridors. Supra-orbital craniotomy offers a minimally invasive access for resection of third ventricular tumors.The trans-lamina terminalis technique through a supra-orbital craniotomy is described. Also, a literature review of clinical outcome data was performed for the comparison of different surgical corridors (anterior, antero-lateral, lateral, and trans-sphenoidal).The operative steps and anatomic landmarks for supra-orbital craniotomy a...

Frontal Sinus Osteoma with Osteoblastoma-like Histology and Associated Intracranial Pneumatocele

Head and Neck Pathology — Tue, 24 Jan 2012 18:14:59 +0100

Abstract Osteomas of the cranial sinuses are rare, benign bony tumors that can be complicated by the formation of an intracranial pneumatocele. If not treated promptly, a pneumatocele can lead to abscess formation, meningitis, or ventriculitis. In the present case, an intracerebral pneumatocele was formed when an 18 cm3 osteoma breached the posterior wall of the frontal sinus creating a one-way valve through which air could enter the intracranial cavity. The patient presented after forceful sneezing with nonspecific symptoms of headache, nausea, and vomiting. CT demonstrated a frontal collection of loculated air with mass effect within the left cerebral hemisphere. A partly mineralized mass occupied the left superior nasal ethmoid sinus and left frontal sinus. Of inter...

Clinical features and surgical management of four peculiar cases of intracranial metastases from renal cell carcinoma

Neurological Sciences — Tue, 24 Jan 2012 07:34:35 +0100

In this study, four patients (age range 56–72 years) were treated for intracranial metastases from renal cell carcinoma. The metastasis was solitary in all four patients and was located in the temporoparietal region in two patients, cerebellum in one patient, and bilateral lateral ventricles in one patient. Preoperative magnetic resonance imaging showed hemorrhage and necrosis in the tumor in all four patients, and one patient had edema in the region of the tumor. All patients were treated with craniotomy for tumor resection, and histopathologic examination showed clear cell carcinoma. Marked bleeding occurred in all patients during the operation, but preoperative direct injection of ethanol into epidural metastases (2 patients) was effective in decreasing intraoperative blood...

Young Man With Fever and Eye Pain

Annals of Emergency Medicine — Fri, 20 Jan 2012 19:16:32 +0100

A 21-year-old man presented with several days of fever, sinus pain, decreased vision, and pain with eye movement. Examination revealed proptosis and periorbital edema/erythema, with an afferent pupillary defect and a visual acuity of hand-motion in the right eye (). A computed tomography (CT) scan showed opacification of the frontal, ethmoid, and maxillary sinuses bilaterally, with right-sided orbital inflammatory changes and a subperiosteal abscess in the superomedial orbit (). The patient began receiving vancomycin, ceftazidime, and metronidazole. He underwent an orbitotomy with subperiosteal abscess drainage and right-sided ethmoidectomy that same day. Abscess cultures grew Staphylococcus aureus and Streptococcus sanguis. Although the external examination showed apparent improvement, th...

Asymptomatic Remote Cerebellar Hemorrhage: CT and MRI Findings.

Cerebellum — Tue, 17 Jan 2012 05:00:00 +0100

Authors: Dincer A, Ozcan U, Kaya D, Usseli MI, Erzen C, Pamir MN Abstract The aim of this study was to evaluate the computed tomography (CT) and magnetic resonance imaging findings (MRI) of asymptomatic remote cerebellar hemorrhage (RCH) at the preoperative, early postoperative, and postoperative period. A total of 983 consecutive adult patients who underwent supratentorial craniotomies were included in the study. The ethics committee approved the study. The patient's clinical records and radiological examinations were retrospectively analyzed. All patients had preoperative CT and MRI examinations, immediate postoperative CT, and postoperative MRI within 24 h. The patients with the radiological diagnosis of RCH were followed up to 5 years. Eight asymptomatic RCH cases were recrui...

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Lateral orbital wall approach to the cavernous sinus.

Journal of Neurosurgery — Fri, 13 Jan 2012 05:00:00 +0100

Conclusions The translateral orbital wall approach provides a simple, rapid approach for lesions with primary or secondary involvement of the cavernous sinus. Advantages of this simple, extradural approach include the lack of brain retraction and no interruption of the temporalis muscle. PMID: 22242672 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

Delayed acute spinal cord injury following intracranial gunshot trauma.

Journal of Neurosurgery — Fri, 13 Jan 2012 05:00:00 +0100

Authors: Cheng JS, Richardson RM, Gean AD, Stiver SI Abstract The authors report the case of a patient who presented with a hoarse voice and left hemiparesis following a gunshot injury with trajectory entering the left scapula, traversing the suboccipital bone, and coming to rest in the right lateral medullary cistern. Following recovery from the hemiparesis, abrupt quadriparesis occurred coincident with fall of the bullet into the anterior spinal canal. The bullet was retrieved following a C-2 and C-3 laminectomy, and postoperative MR imaging confirmed signal change in the cord at the level where the bullet had lodged. The patient then made a good neurological recovery. Bullets can fall from the posterior fossa with sufficient momentum to cause an acute spinal cord injury. Conside...

Infective endocarditis with cerebrovascular complications: timing of surgical intervention

Interactive CardioVascular and Thoracic Surgery — Mon, 09 Jan 2012 05:00:00 +0100

Management of infective endocarditis (IE) with cerebrovascular complications is difficult due to absence of concrete evidence. These patients usually have multiple neurological deficits and the optimal timing for cardiac operation remains controversial. The aims of this study were to present cases and discuss the treatment options for IE with cerebrovascular complications. From 1998 to 2010, 51 patients underwent operations for IE at our institution. From a review of medical records, 10 patients (19.6%) with preoperative neurological complications were identified. Data on these 10 patients were analysed. Cerebrovascular complications included cerebral infarction (n = 4, 40.0%), mycotic aneurysm (n = 1, 10.0%), mycotic aneurysm plus cerebral infarction (n = 3, ...

Role of Preoperative 3-Dimensional Computed Tomography Reconstruction in Depressed Skull Fractures Treated With Craniectomy: A Case Report of Forensic Interest. - Viel G, Cecchetto G, Manara R, Cecchetto A, Montisci M.

SafetyLit: All (Unduplicated) — Fri, 06 Jan 2012 15:21:09 +0100

Patients affected by cranial trauma with depressed skull fractures and increased intracranial pressure generally undergo neurosurgical intervention. Because craniotomy and craniectomy remove skull fragments and generate new fracture lines, they complicate ... (Source: SafetyLit: All (Unduplicated))

Incidence and causes of perioperative mortality after primary surgery for intracranial tumors: a national, population-based study.

Journal of Neurosurgery — Fri, 06 Jan 2012 05:00:00 +0100

Conclusions Although considered surgically related if they occur within the first 30 days of surgery, most early postoperative deaths can happen independent of the handiwork of the operating surgeon or anesthesiologist. Overall prognosis of the disease seems to be a strong predictor of perioperative death-perhaps not surprisingly since the 30-day mortality rate is merely the intonation of the Kaplan-Meier curve. Both referral and treatment policies at a neurosurgical center will therefore markedly affect such early outcomes, but early deaths may not necessarily reflect overall quality of care or long-term results. The low incidence of perioperative death in intracranial tumor surgery also greatly limits the statistical power in comparative analyses, such as between published patient serie...

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Ruptured ovarian metastatic malignant melanoma caused acute abdomen

Central European Journal of Medicine — Fri, 30 Dec 2011 07:07:45 +0100

We present a rare case of acute abdomen due to rupture of ovarian metastatic malignant melanoma seven years after removal of a primary cutaneous malignant melanoma lesion, followed by reexcision of the cicatrix and axillary dissection (Clark III, Breslow IV), one year after osteoplastic parietal craniotomy for removal of recidiv metastatic lesions, and excision of the cutaneous malignant melanoma lesion on the upper leg were performed. During laparotomy because of acute abdomen, 4 L of free liquid (blood and ascites) were evacuated. The right adnexal mass was loose tumor, size 110x75 mm, with rupture on the posterior wall and hemorrhage. Unilateral adnexectomy was performed. Pathohystologic evaluation revealed tumor cells with eosinophilic, clear cytoplasm, intracytoplasmatic melanot...

Percutaneous evacuation for treatment of subdural hematoma and outcome in 28 patients.

Turkish Neurosurgery — Thu, 29 Dec 2011 18:00:03 +0100

CONCLUSION: Treatment of chronic subdural hematoma using a percutaneous operative technique is a minimally invasive method with sufficient outcome and a therapeutic alternative to the craniotomy. PMID: 22194110 [PubMed - in process] (Source: Turkish Neurosurgery)

Complications of delayed cranial repair after decompressive craniectomy in children less than 1 year old

Acta Neurochirurgica — Mon, 26 Dec 2011 06:32:53 +0100

Conclusions Infants less than 1 year old, undergoing decompressive craniectomy after traumatic brain injury, experience a high rate of complications following subsequent cranial repair. Subdural collections and resorption of the autologous bone flap are to be considered as extremely common complications. Content Type Journal ArticleCategory Clinical ArticlePages 1-7DOI 10.1007/s00701-011-1253-5Authors Paolo Frassanito, Pediatric Neurosurgery, Policlinic A. Gemelli, Catholic Medical School, Rome, ItalyLuca Massimi, Pediatric Neurosurgery, Policlinic A. Gemelli, Catholic Medical School, Rome, ItalyMassimo Caldarelli, Pediatric Neurosurgery, Policlinic A. Gemelli, Catholic Medical School, Rome, ItalyGianpiero Tamburrini, Pediatric Neurosurgery, Policlinic A. Gemelli, C...

Associated injuries in casualties with traumatic lower extremity amputations caused by improvised explosive devices

British Journal of Surgery — Wed, 21 Dec 2011 05:00:00 +0100

Conclusion:Higher levels of amputation were associated with greater injury burden and mortality. Intraoperative computed tomography had little value in identifying clinically significant covert injuries. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. (Source: British Journal of Surgery)

Similarity metrics for surgical process models

Artificial Intelligence in Medicine — Sat, 17 Dec 2011 15:37:48 +0100

The objective of this work is to introduce a set of similarity metrics for comparing surgical process models (SPMs). SPMs are progression models of surgical interventions that support quantitative analyses of surgical activities, supporting systems engineering or process optimization.Methods and materials: Five different similarity metrics are presented and proven. These metrics deal with several dimensions of process compliance in surgery, including granularity, content, time, order, and frequency of surgical activities. The metrics were experimentally validated using 20 clinical data sets each for cataract interventions, craniotomy interventions, and supratentorial tumor resections. The clinical data sets were controllably modified in simulations, which were iterated ten times, resulting...

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Controlled cortical impact injury and craniotomy result in divergent alterations of pyruvate metabolizing enzymes in rat brain.

Experimental Neurology — Wed, 14 Dec 2011 05:00:00 +0100

Authors: Xing G, Ren M, O'Neill JT, Watson WD, Verma A Abstract Dysregulated glucose metabolism and energy deficit is a characteristic of severe traumatic brain injury (TBI) whose mechanism remains to be fully elucidated. Phosphorylation of pyruvate dehydrogenase (PDH) is the rate-limiting mitochondria enzyme coupling glycolysis to the tricarboxylic acid cycle. Phosphorylation of PDH E1α1 subunit catalyzed by PDH kinase (PDK) inhibits PDH activity effectively decoupling aerobic glycolysis whereas dephosphorylation of phosphorylated PDHE1α1 by PDH phosphatase (PDP) restores PDH activity. We recently reported altered expression and phosphorylation of pyruvate dehydrogenase (PDH) following TBI. However, little is unknown about PDK and PDP's involvement. We determined PDK (PDK1-4) an...

Fourth Ventricular Schwannoma: Identical Clinicopathologic Features as Schwann Cell-Derived Schwannoma with Unique Etiopathologic Origins

Infectious Diseases in Obstetrics and Gynecology — Tue, 13 Dec 2011 16:29:07 +0100

Conclusions. Schwannomas should be considered in the differential diagnosis of intraventricular tumors. Although the embryologic origins may be different from nerve sheath-derived schwannomas, the histologic, clinical, and natural history appear identical and thus should be managed similarly. (Source: Infectious Diseases in Obstetrics and Gynecology)

Adjuvant or radical fractionated stereotactic radiotherapy for patients with pituitary functional and nonfunctional macroadenoma.

Radiation Oncology — Thu, 08 Dec 2011 05:00:00 +0100

Conclusions: SFRT is a safe and effective treatment for patients with PMA, although longer follow-up is needed to evaluate long-term outcomes. In this study, approximately 1 patient with visual field defect out of two had an improved visual function. (Source: Radiation Oncology)

Ruptured Intracranial Aneurysms and the Timing of Embosurgery

Academic Radiology — Wed, 07 Dec 2011 20:35:05 +0100

Among the many variables that influence outcomes in acute subarachnoid hemorrhage resulting from a ruptured cerebral aneurysm (aSAH), the three most consistent predictors of a dismal outcome are poor initial clinical presentation, advanced age, and aneurysm rebleeding . As a result, the management of aSAH is focused largely on securing the culprit aneurysm from future rehemorrhage. Craniotomy with clipping and endovascular coil embolization (embosurgery) are both effective in this regard, although the landmark International Subarachnoid Aneurysm Trial demonstrated superior short- and long-term outcomes for embosurgery . (Source: Academic Radiology)

Epidemiological and economic aspects of polytrauma management in Austria.

Wiener Klinische Wochenschrift — Mon, 05 Dec 2011 05:00:00 +0100

DISCUSSION: The data demonstrate the broad spectrum of polytrauma treatment in Austrian trauma centers. The discussed need for centralization of polytrauma care cannot be justified based on these data. Limiting from a medical perspective, however, is the lacking comparability of quality of care due to the currently missing objective quality criteria. PMID: 22138762 [PubMed - as supplied by publisher] (Source: Wiener Klinische Wochenschrift)

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Nasal Endoscopic and Anterior Craniotomy Resection for Esthesioneuroblastoma: How We Did It

Indian Journal of Otolaryngology and Head and Neck Surgery — Fri, 02 Dec 2011 17:28:54 +0100

In conclusion endoscopic excision complimented with anterior craniotomy for the anterior cranial fossa extension of resectable ENB with post-op radiotherapy is an effective treatment modality satisfying both oncosurgical as well as esthetic requirements. Content Type Journal ArticleCategory Clinical ReportPages 1-4DOI 10.1007/s12070-011-0358-8Authors Somani Sham, Department of E.N.T., M.I.M.S.R. Medical College, Latur, IndiaNaik Chetana, Department of E.N.T., S.K.N. Medical College, Pune, India Journal Indian Journal of Otolaryngology and Head & Neck SurgeryOnline ISSN 0973-7707Print ISSN 2231-3796 (Source: Indian Journal of Otolaryngology and Head and Neck Surgery)

Transzygomatic Approach with Intraoperative Neuromonitoring for Resection of Middle Cranial Fossa Tumors

Skull Base — Fri, 02 Dec 2011 05:00:00 +0100

Skull BaseDOI: 10.1055/s-0031-1296041The authors reviewed the surgical experience and operative technique in a series of 11 patients with middle fossa tumors who underwent surgery using the transzygomatic approach and intraoperative neuromonitoring (IOM) at a single institution. This approach was applied to trigeminal schwannomas (n = 3), cavernous angiomas (n = 3), sphenoid wing meningiomas (n = 3), a petroclival meningioma (n = 1), and a hemangiopericytoma (n = 1). An osteotomy of the zygoma, a low-positioned frontotemporal craniotomy, removal of the remaining squamous temporal bone, and extradural drilling of the sphenoid wing made a flat trajectory to the skull base. Total resection was achieved in 9 of 11 patients. Significant motor pathway damage can be avoided us...

Endoscopic approaches to the cavernous sinus

Operative Techniques in Otolaryngology - Head and Neck Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Skull base tumors that involve the cavernous sinus (CS) present a challenge to the endoscopic surgeon. Most such lesions arise from sellar pathology that involves the medial wall of the CS, which can be accessed by a transsphenoidal transsellar approach. Tumors that arise primarily in the medial CS may be accessed via a transethmoidal transsphenoidal parasellar approach, which avoids the dissection of sellar contents but requires the removal of bone overlying the carotid artery. Involvement of the tumor in the lateral CS may be accessed by a transmaxillary transpterygoid approach in patients who wish to avoid a craniotomy and in whom radiosurgery is not an option. These tumors are associated with a greater risk of cranial nerve injury, including extraocular palsy. Important adjuncts to the...

Combined endoscopic and open approach to resection of the anterior skull base

Operative Techniques in Otolaryngology - Head and Neck Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Although en-bloc resection is the traditional teaching in oncological surgery, with recent technologic advancements and literature to support both safety and efficacy, there has been a growing acceptance of alternative techniques for the surgical management of paranasal sinus and anterior skull base malignancies. The endoscopic-assisted external approach affords many of the benefits of endoscopic resection while allowing for the management of lesions with marked intracranial extension that would otherwise require anterior craniofacial resection. Here we describe our endoscopic technique for resection of the anterior skull base and its role when combined with anterior craniotomy. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)

Weekend and Night Outcomes in a Statewide Trauma System: Carr BG, Wiebe DJ, Reilly PM, et al. Arch Surg 2011;146:810–7.

The Journal of Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

The differential quality of “off-hours” care for critical conditions has been cited repeatedly in the literature across a spectrum of diseases and specialties. In this article, the authors sought to evaluate whether trauma patients in a well-established regional trauma system were also subject to the so-called “weekend effect.” Retrospective data were collected on all adult trauma patients admitted to an accredited trauma center in Pennsylvania over a 5-year period, looking at in-house mortality, length of stay (LOS), and delay over 2 h to laparotomy or craniotomy. The data were subdivided by patient arrival time as weekday, weeknight, or weekend admissions. In unadjusted analyses of the data, the authors found that patients presenting on weeknights had a higher in-hospital mortali...

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Spontaneous Cerebrospinal Fluid Leak through the Posterior Aspect of the Petrous Bone

Skull Base — Wed, 30 Nov 2011 05:00:00 +0100

Skull BaseDOI: 10.1055/s-0031-1296040Spontaneous cerebrospinal fluid (CSF) leak through the posterior fossa (PF) aspect of the petrous bone is exceedingly rare. A case series allows analysis of etiologies and how they may differ from the more common middle fossa (MF) route of leakage. The design was a retrospective case series. The setting was a tertiary care institution. A series of three patients with PF spontaneous CSF leaks was identified. High-resolution imaging (CT and MRI) and intraoperative observations were evaluated. Both in this series and in previously reported cases, patients share the demographics typically found in the MF leak population. In our series, two patterns of PF CSF leak were identified: (1) large unilateral with cerebellar encephalocele and (2) small punctate defe...

Anesthesia Considerations and Intraoperative Monitoring During Surgery for Arteriovenous Malformations and Dural Arteriovenous Fistulas

Neurosurgery Clinics of North America — Wed, 23 Nov 2011 20:21:23 +0100

The anesthetic considerations for surgical resection of arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) incorporate many principles that are common to craniotomies for other indications. However, a high-flow, low-resistance shunt results in chronic hypoperfusion of adjacent brain tissue that is vulnerable to ischemia and at high risk for hyperemia and hemorrhage as resection of the lesion redirects blood flow. A comprehensive understanding of AVM pathophysiology and rapidly titratable anesthetic and vasoactive agents allow the anesthesiologist to alter blood pressure targets as resection evolves for optimal patient outcome. Intensive management is continued post-operatively as the brain acclimatizes to new parameters. (Source: Neurosurgery Clinics of North Ameri...

Multiple tenting techniques improve dead space obliteration in the surgical treatment for patients with giant calcified chronic subdural hematoma

Acta Neurochirurgica — Wed, 23 Nov 2011 16:32:39 +0100

Conclusions We reported an alternative technique using multiple tenting procedures to improve dead space obliteration after surgical treatment for patients with a large CCSDH presenting as a late complication after V-P shunting. Content Type Journal ArticleCategory Technical NotePages 1-4DOI 10.1007/s00701-011-1234-8Authors Wei-Sheng Juan, Neurosurgical Service, Department of Surgery, National Cheng Kung University Hospital, Tainan, TaiwanShih-Huang Tai, Neurosurgical Service, Department of Surgery, National Cheng Kung University Hospital, Tainan, TaiwanYu-Chang Hung, Neurosurgical Service, Department of Surgery, National Cheng Kung University Hospital, Tainan, TaiwanE-Jian Lee, Neurosurgical Service, Department of Surgery, National Cheng Kung University Hospital, Ta...

Surgical Strategies for Supra- and Infratentorially Grown Occipital Meningeomas

Zentralblatt fur Neurochirurgie - Central European Neurosurgery — Mon, 21 Nov 2011 05:00:00 +0100

Cen Eur NeurosurgDOI: 10.1055/s-0031-1283120Extensive tentorial meningeomas which are growing supra- and infratentorially are a surgical challenge, and a distinct surgical strategy is required for good results.3 patients, 2 with asymptomatic tumor and 1 with signs of increased intracranial pressure and visual disorder underwent microsurgery. In 2 patients, the semi-sitting position was taken. A lateralized occipital/suboccipital craniotomy with exposure of the confluens sinuum, transverse and superior sagittal sinus was performed. First, the dura was opened infratentorially allowing good cerebrospinal fluid (CSF) release. In a second step the dura was opened supratentorially sparing the sinus. The tumor was then removed completely without brain swelling or significant venous bleeding. One ...

The effects of anaesthetic agents on cortical mapping during neurosurgical procedures involving eloquent areas of the brain.

Cochrane Database of Systematic Reviews — Sun, 20 Nov 2011 22:06:03 +0100

CONCLUSIONS: This review highlights the need for well-designed randomised controlled trials to assess the effect of anaesthetic agents on cortical mapping during neurosurgical procedures involving eloquent areas of the brain. PMID: 22071831 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

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An episode of severely suppressed electrocerebral activity recorded by electroencephalography during endoscopic resection of a colloid cyst.

Journal of Neurosurgery — Fri, 18 Nov 2011 05:00:00 +0100

Authors: Munich SA, Sazgar M, Grand W, Leonardo J Abstract Intraoperative neuromonitoring utilizing electroencephalography (EEG) is rarely performed during neuroendoscopy. The authors present a case in which this monitoring modality was used for a patient with a colloid cyst in preparation for an open craniotomy should an endoscopic approach fail. In this case, EEG serendipitously captured near-complete cessation of electrocerebral activity that occurred during intraventricular irrigation in response to ventricular collapse and resulted in no postoperative deficits. To the authors' knowledge, this is the first reported case of severe suppression of electrical activity captured by EEG during neuroendoscopy. Although they describe a transient phenomenon that resulted in no residual c...

Intra-operative monitoring of lower extremity motor-evoked potentials by direct cortical stimulation.

Clinical Neurophysiology — Fri, 18 Nov 2011 05:00:00 +0100

CONCLUSIONS: We accomplished LE-MEP recording during supratentorial surgery using monopolar DCS with a subdural electrode placed on the convex side of the motor cortex. SIGNIFICANCE: A useful method of intra-operative LE-MEP recording was described. PMID: 22104472 [PubMed - as supplied by publisher] (Source: Clinical Neurophysiology)

Noncardiac Surgery in the Prone Position in Patients With Ventricular Assist Devices

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 18 Nov 2011 05:00:00 +0100

After a literature review and PubMed search using the key words “prone,” “ventricular assist device,” “noncardiac surgery,” and “position,” we report the first case of surgery in the prone position in a patient with a ventricular assist device (VAD). A 72-year-old woman with a previously implanted Heartmate II (Thoratec Corporation, Pleasanton, CA) Left Ventricular Assist Device presented to the authors' institution with an expanding right frontoparietal hematoma and left-sided hemiplegia. As such, the patient proceeded to the operating room for a right parietal craniotomy for decompression of an intracerebral hematoma. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Success of pure neuroendoscopic technique in the treatment of Sylvian arachnoid cysts in children

Child's Nervous System — Wed, 16 Nov 2011 17:59:19 +0100

In this study, the authors discuss their experience on pure neuroendoscopic technique in the treatment of SACs in children. Results The results of treatment of 20 children (range of age, between 7 months and 17 years) with Galassi type II (n, 5) or III (n, 15) SACs who were subjected to pure neuroendoscopic fenestration procedure were presented. It was possible to perform the cystocisternostomy endoscopically in all children with several stomies. The site of the opening was between the optic nerve and the carotid artery in 19, between the carotid artery and the oculomotor nerve in 17, and below the oculomotor nerve in 7. The stomies were enlarged in all cases using the double balloon. Three of the cases required repetition of the operation and two cases r...

Accidental Subcutaneous Remifentanil Infusion as a Cause of Delayed Awakening after Craniotomy

Infectious Diseases in Obstetrics and Gynecology — Fri, 04 Nov 2011 01:31:20 +0100

We report a case of accidental subcutaneous infusion of remifentanil as a cause of delayed awakening after a craniotomy. (Source: Infectious Diseases in Obstetrics and Gynecology)

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Unusual clinical and radiological presentation of metastatic choriocarcinoma to the brain and long-term remission following emergency craniotomy and adjuvant EMA-CO chemotherapy: Response to the Letter

Journal of Cancer Research and Therapeutics — Wed, 02 Nov 2011 04:00:00 +0100

Ravi Dadlani, Sunil V Furtado, Nandita Ghosal, Alangar S HegdeJournal of Cancer Research and Therapeutics 2011 7(3):384-385 (Source: Journal of Cancer Research and Therapeutics)

Reducing Time-to-Treatment Decreases Mortality of Trauma Patients with Acute Subdural Hematoma: Tien HC, Jung V, Pinto R, Mainprize T, Scales DC, Rizoli SB. Ann Surg 2011;253:1178–83.

The Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

The “golden hour” in the treatment of the trauma patient is a well-known concept suggesting that early assessment and treatment of a trauma patient will maximize the likelihood of survival. Although often cited in textbooks and widely taught within the classroom, there are few objective data demonstrating that the early treatment of the trauma patient results in improved outcomes. This retrospective cohort study from a single large urban Canadian trauma center attempted to determine if there was a survival benefit with reduced pre-hospital time and time to craniotomy in patients sustaining isolated acute subdural hematomas. Excluding patients referred from outside hospitals, those with penetrating trauma, severe torso injury, and intoxication, the final study population of patients who...

Discrepancy in EBV-DNA load between peripheral blood and cerebrospinal fluid in a patient with isolated CNS post-transplant lymphoproliferative disorder.

International Journal of Hematology — Sat, 29 Oct 2011 04:00:00 +0100

Authors: Shimizu H, Saitoh T, Koya H, Yuzuriha A, Hoshino T, Hatsumi N, Takada S, Nagaki T, Nojima Y, Sakura T Abstract Post-transplant lymphoproliferative disorder (PTLD) is a fatal complication of allogeneic hematopoietic stem cell transplantation (HSCT) that is caused by reactivation of Epstein-Barr virus (EBV). A successful approach, monitoring EBV-DNA load in peripheral blood (PB) accompanied by preemptive rituximab therapy, has recently been reported. Here, we describe a 29-year-old woman who developed isolated central nervous system (CNS) PTLD. She received HSCT against acute myelogenous leukemia from a related human leukocyte antigen-haploidentical donor, following a conditioning regimen that included antithymocyte globulin. Tacrolimus and methylprednisolone were given as p...

Optic Canal Decompression With Dural Sheath Release; A Combined Orbito-Cranial Approach To Preserving Sight From Tumours Invading The Optic Canal.

Orbit — Wed, 26 Oct 2011 04:00:00 +0100

Conclusions: In cases of non-resectable meningioma extending into the optic canal with secondary optic nerve compression, a combined surgical approach with optic canal decompression and dural sheath release may help preserve and even improve vision in certain cases. PMID: 22029716 [PubMed - as supplied by publisher] (Source: Orbit)

Infrasellar craniopharyngioma

Clinical Neurology and Neurosurgery — Mon, 24 Oct 2011 04:00:00 +0100

Conclusions: IC is rare (the present cases account for 0.23% of all retrieved cases). Its chief clinical manifestations include headache, nasal obstruction, polydipsia and polyuria, and visual disorder. Lesions include solid, cystic, and mixed cystic and solid types. It is very difficult to resect the whole diseased region because this disease invades the cranial base, nasal sinuses and nasopharynx. Individualized treatments should be used according to lesion characteristics and invasion range, for example, stereotaxic interstitial brachytherapy. Radical resection or partial resection plus external beam radiation therapy produces better prognosis in IC than intracranial craniopharyngioma. (Source: Clinical Neurology and Neurosurgery)

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Minimally invasive transfrontal sinus approach to resection of large tumors of the subfrontal skull base

The Laryngoscope — Sat, 22 Oct 2011 08:45:31 +0100

Conclusions:The minimally invasive transfrontal sinus approach to the subfrontal region provides ready expeditious access to the base of the anterior cranial fossa without the need for brain retraction, craniotomy or naso‐orbital osteotomies. It represents an excellent alternative in the surgical access of both intra‐ and extradural tumors in this region of the skull base. Laryngoscope, 121:2290–2294, 2011 (Source: The Laryngoscope)

Iatrogenic false aneurysm caused by surgery of a traumatic intracranial false aneurysm

Neurology India — Sat, 22 Oct 2011 04:00:00 +0100

Xiang Wang, Jin-Xiu Chen, Chao YouNeurology India 2011 59(5):753-755A superficial temporal artery (STA) false aneurysm caused by surgery of a traumatic intracranial false aneurysm is reported. A 28-year-old man underwent craniotomy for aneurysm clipping 20 days after traumatic head injury. At surgery the aneurysm was a false aneurysm due to its avulsion from the parent artery without a real neck. A "clip wrapping" technique was used to repair the deficit on the parent artery. On postoperative Day 25, repeat digital subtraction angiogram (DSA) revealed a new right STA aneurysm, which was not apparent in the preoperative DSA. We feel that this aneurysm might have probably resulted from the iatrogenic injury to the STA during the initial surgery as the location of aneurysm was at th...

Primary intracranial Ewing sarcoma with an unusually aggressive course: A case report and review of the literature

Neuropathology — Tue, 18 Oct 2011 04:00:00 +0100

We present the clinical, radiologic and pathologic findings of an intracranial Ewing sarcoma in a 22‐year‐old woman arising from the dura over the right frontal convexity. The patient underwent craniotomy with gross total excision of the tumor. The tumor showed atypical histology and the diagnosis was confirmed by detection of a rearrangement of the EWSR1 gene by fluorescent in situ hybridization and identification of the diagnostic t(11;22)(q24;q12) translocation by reverse transcription‐polymerase chain reaction. Additional features were detected in this tumor that are known to be associated with an unfavorable prognosis, including loss of p16 expression and gains of chromosomes 1q and 12. The patient experienced the most rapid downhill course reported to date for intracranial Ewin...

Post-craniotomy neuronavigation based purely on intraoperative ultrasound imaging without preoperative neuronavigational planning

Neurosurgical Review — Mon, 17 Oct 2011 16:03:22 +0100

Abstract Neuronavigation has become an established technology which provides objective data for localization in 3D space and thus decreases uncertainties regarding tumor localization, relation to vasculature, safe trajectories, and craniotomy design during surgery. We have evaluated whether neuronavigation based purely on 3D ultrasound without any preoperative navigational imaging can provide necessary information for navigation and resection control. This application is a new way of utilizing ultrasound-guided neuronavigation. Eighteen patients were operated on with ultrasound-based navigation only; they represented 16% of all the 131 navigation-assisted procedures during our 1-year study period. Of the procedures, 2 were planned as diagnostic biopsies, 1 was resection of...

Prognostic factors and survival in a prospective cohort of patients with high-grade glioma treated with carmustine wafers or temozolomide on an intention-to-treat basis

Acta Neurochirurgica — Fri, 14 Oct 2011 10:39:41 +0100

Conclusions In this prospective cohort of patients, analysed on the basis of intention-to-treat at the time of the first surgery, no statistically significant differences in survival were found between the two treatment modalities (carmustine wafers vs. first-line systemic chemotherapy). On the other hand, age, preoperative KPS, histological grade, and RPA class were confirmed to be prognostic factors in this cohort. Finally, the extent of resection was also found to influence survival. Content Type Journal ArticleCategory Clinical ArticlePages 1-12DOI 10.1007/s00701-011-1199-7Authors Gregorio Catalán-Uribarrena, Cruces University Hospital, Baracaldo (Vizcaya), SpainGaizka Bilbao-Barandica, Cruces University Hospital, Baracaldo (Vizcaya), SpainIñigo Pomposo-Gazte...

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Human cerebral microcirculation and oxygen saturation during propofol-induced reduction of bispectral index

British Journal of Anaesthesia — Thu, 13 Oct 2011 04:00:00 +0100

Conclusions Findings suggest alteration of the CBF/CMRO2 ratio by propofol in cortical brain regions; therefore, it might be possible that propofol affects coupling of flow and metabolism in the cerebral microcirculation. (Source: British Journal of Anaesthesia)

50 Years Ago in The Journal of Pediatrics: Precocious Puberty Due to Secreting Chorionepithelioma (Teratoma) of the Brain

The Journal of Pediatrics — Wed, 12 Oct 2011 18:14:09 +0100

Bruton OC, Martz DC, Gerard ES. J Pediatr 1961;59:719-25 Fifty years ago in The Journal, Bruton et al wrote, “It is evident that an early diagnosis could not be established in this case,” about a 7-year-old child with precocious puberty from a mixed germ cell brain tumor, diagnosed ultimately at death. In the course of 6 months from presentation, the boy underwent testicular biopsy, multiple blood tests, two electroencephalograms, pneumoencephalography, non-diagnostic posterior fossa craniotomy, and finally, repeat craniotomy with an aborted attempt to explore the third ventricle. The surgeon visualized but could not resect the tumor, so the patient was treated with 4000 cGy of irradiation before dying 12 months after the diagnosis. At autopsy, the boy was found to have a 6- by 5- by...

Ganglioglioma of the Right Lateral Ventricle Approached with Neuronavigation and Intraoperative DTI. Case Report and Literature Review.

Zentralblatt fur Neurochirurgie - Central European Neurosurgery — Wed, 12 Oct 2011 04:00:00 +0100

Conclusions: Intraoperative MRI with DTI allows to treat such lesions via minimally invasive approaches and to reduce operative morbidity due to fiber tract damage.[...]© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: Zentralblatt fur Neurochirurgie - Central European Neurosurgery)

Tumors of the posterior third ventricular region in pediatric patients: The Indian perspective and a review of literature

Journal of Pediatric Neurosciences — Mon, 10 Oct 2011 04:00:00 +0100

Conclusions: Histopathologic characterization of TPTVR is essential prior to their further management. Benign lesions often have a good prognosis following gross total surgical resection. Pure germinomas are highly susceptible to radiotherapy. NGGCTs often have malignant components that require adjuvant therapy following surgery. The advancements in microsurgical techniques have led to gratifying perioperative results in these deep-seated lesions. (Source: Journal of Pediatric Neurosciences)

The quiet revolution: retractorless surgery for complex vascular and skull base lesions.

Journal of Neurosurgery — Fri, 07 Oct 2011 04:00:00 +0100

Conclusions Fixed retraction can be supplanted by dynamic retraction with surgical instruments, limiting the risk of retractor-induced tissue edema and injury. This quiet revolution has precipitated a major change in surgical techniques. Extensive dissection of arachnoidal planes, careful placement of the handheld suction device, patient positioning that enhances gravity retraction, the refinement of microsurgical instrumentation, and appropriate selection of the operative corridor all serve to obviate the need for fixed retraction in most intracranial procedures. Retractorless neurosurgery is an achievable goal, even when complex lesions of the vasculature and skull base are being treated. PMID: 21981642 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

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The Dorsal Sagittal Venous Sinus Anatomical Variations in Brachycephalic, Dolichocephalic, and Mesocephalic Dogs and Their Significance for Brain Surgery.

Anatomical Record — Tue, 04 Oct 2011 04:00:00 +0100

Authors: Carreira LM, Ferreira A, Burilo FL Abstract Dorsal sagittal venous sinus (DSVS) is an encephalic structure located in the midline of brain dorsal surface, starting behind the frontal venous sinus and following the brain falx in its extension. Knowing DSVS morphology and cranial-cerebral relationships it is very important for surgeon when he is planning the placement of craniotomies, in order to prevent the damage of this structure. The main purpose of this study were to establish craniometric points that can be used as key points of neurosurgical importance providing an anatomic framework to brain access regarding the localization of DSVS, and to characterize the morphology of DSVS in the three groups considered in study according their type of skull (brachycephalic-B, dol...

The Dorsal Sagittal Venous Sinus Anatomical Variations in Brachycephalic, Dolichocephalic, and Mesocephalic Dogs and Their Significance for Brain Surgery

Sat, 01 Oct 2011 04:00:00 +0100

AbstractDorsal sagittal venous sinus (DSVS) is an encephalic structure located in the midline of brain dorsal surface, starting behind the frontal venous sinus and following the brain falx in its extension. Knowing DSVS morphology and cranial‐cerebral relationships it is very important for surgeon when he is planning the placement of craniotomies, in order to prevent the damage of this structure. The main purpose of this study were to establish craniometric points that can be used as key points of neurosurgical importance providing an anatomic framework to brain access regarding the localization of DSVS, and to characterize the morphology of DSVS in the three groups considered in study according their type of skull (brachycephalic‐B, dolychocephalic‐D and mesocephalic‐M). The study...

Transorbital and transnasal endoscopic repair of a meningoencephalocele.

Orbit — Sat, 01 Oct 2011 04:00:00 +0100

Authors: Schaberg M, Murchison AP, Rosen MR, Evans JJ, Bilyk JR Abstract A 71-year-old female with a history of thyroid eye disease (TED) presented for evaluation of a skull base mass noted on neuroimaging. She had previously undergone bilateral orbital decompressions and strabismus surgery and had no neurologic symptoms. Successful resection of the menigoencephalocele and repair of the skull base defect was performed through a combined transnasal endoscopic and transorbital approach, obviating the need for craniotomy. PMID: 21957950 [PubMed - in process] (Source: Orbit)

The Oxford cranioplasty series: an analysis of cranioplasty procedures undertaken by maxillofacial, plastic- and neuro-surgeons in the oxford region over the last decade

International Journal of Oral and Maxillofacial Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Introduction: Craniofacial access required in the treatment of craniofacial pathology is typically achieved through a craniotomy or craniectomy. Depending on the extent of the resulting cranial defect there are cosmetic, functional and therapeutic reasons necessitating repair, either immediately or as a delayed procedure. This repair, known as a cranioplasty, can be undertaken in a variety of ways but there currently exists very little to inform of how and when it should be done. (Source: International Journal of Oral and Maxillofacial Surgery)

Application of the methylmethacrylate in the oral and maxillofacial surgery

International Journal of Oral and Maxillofacial Surgery — Sat, 01 Oct 2011 04:00:00 +0100

The methylmethacrylate was first synthesized in 1902 by Röhm, a German chemical, and was patented by the name of Plexiglas in 1928. This alloplastic material had its first use, for medical purposes, in 1936 as dental prosthetics. In 1940 the methylmethacrylate was used to cover a major defect at the skull due to craniotomy. The use of methylmethacrylate at maxillofacial procedures it is basically as a fill material for facial defects, it can be used for maxillofacial trauma procedures, reconstructive procedures and even for orthognatic surgery, it is a safe material and your use usually do not promote side effect, due to its properties that are almost ideal, it is a chemically inert material, biocompatible, noncarcinogenic, low cost, easy to handle and stabilize, it does not alter its for...

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New methods and classifications of frontal bone advancement to match later “Intraoral Le Fort II or III Osteotomy”

International Journal of Oral and Maxillofacial Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Cranioplasty is required in craniofacial deformity including craniosynostosis and craniofaciosynostosis, prior to performing midfacial orthognathic surgery which “Intraoral Le Fort II or III Osteotomies” were introduced in 1994. A craniotomy design for advancement of frontal bone is usually required and important to match later “Intraoral Le Fort II or III Osteotomy”. New classification of three types of Fronto-Orbital Bandeau to match later Intraoral Le Fort II or III Osteotomy will be introduced. And implication of angulation of anterior frontal bone will be discussed and their three classifications with clinical application methods will be introduced. (Source: International Journal of Oral and Maxillofacial Surgery)

Assessment of platelet transfusion for reversal of aspirin after traumatic brain injury

Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Background: Platelet transfusion is utilized increasingly for traumatic brain injury (TBI) for the reversal of aspirin (ASA) therapy. Assessment of platelet inhibition and reversal by platelet transfusion after TBI has not been adequately characterized.Methods: A retrospective cohort analysis of TBI patients at a level I trauma center (January 2008–December 2009) was performed. The Aspirin Response Test (ART; VerifyNow) was used to assess platelet inhibition in TBI patients and guide platelet transfusion in patients with ASA-induced suppression. A follow-up ART was obtained after platelet administration. Primary endpoints were progression of intracranial hemorrhage on computed tomography, need for craniotomy, and mortality.Results: We analyzed 84 patients (median age, 78 [interquartile r...

Ankylosis of temporomandibular joint after the traumatic brain injury: a report of two cases

Dental Traumatology — Sat, 01 Oct 2011 04:00:00 +0100

This article reports two unusual cases with the intra‐articular ankylosis of temporomandibular joint after the traumatic brain injury, who received a modified surgical treatment for joint ankylosis. Therefore, the early diagnosis and intervention are important to minimize these complications. (Source: Dental Traumatology)

Primary frontal sinus carcinoma with extradural anterior cranial fossa involvement.

Ear, Nose and Throat Journal — Sat, 01 Oct 2011 04:00:00 +0100

We report the case of a 48-year-old woman with a carcinoma that originated in the frontal sinus. Computed tomography and magnetic resonance imaging demonstrated bony destruction with intracranial extension but no involvement of the bulbus. The patient underwent a frontal craniotomy, tumor excision, and postoperative radiotherapy. One year later, she remained symptom-free. PMID: 22033970 [PubMed - in process] (Source: Ear, Nose and Throat Journal)

Anterior Spinal Artery Syndrome in a Patient with Vasospasm Secondary to a Ruptured Cervical Dural Arteriovenous Fistula

Journal of Neuroimaging — Sat, 01 Oct 2011 04:00:00 +0100

CONCLUSIONSFor patients with subarachnoid hemorrhage of unknown origin, differential diagnosis should include DAVF. This patient also presented with vasospasm in the context of ruptured DAVF, a complication previously unreported in the literature. This finding suggests that close monitoring for vasospasm after rupture of DAVF is warranted.J Neuroimaging 2011;XX:1–4. (Source: Journal of Neuroimaging)

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A micro-electrocorticography platform and deployment strategies for chronic BCI applications.

Clinical EEG and Neuroscience — Sat, 01 Oct 2011 04:00:00 +0100

Authors: Thongpang S, Richner TJ, Brodnick SK, Schendel A, Kim J, Wilson JA, Hippensteel J, Krugner-Higby L, Moran D, Ahmed AS, Neimann D, Sillay K, Williams JC Abstract Over the past decade, electrocorticography (ECoG) has been used for a wide set of clinical and experimental applications. Recently, there have been efforts in the clinic to adapt traditional ECoG arrays to include smaller recording contacts and spacing. These devices, which may be collectively called "micro-ECoG" arrays, are loosely defined as intercranial devices that record brain electrical activity on the sub-millimeter scale. An extensible 3D-platform of thin film flexible micro-scale ECoG arrays appropriate for Brain-Computer Interface (BCI) application, as well as monitoring epileptic activity, is presented. ...

In vivo MR quantification of superparamagnetic iron oxide nanoparticle leakage during low‐frequency‐ultrasound‐induced blood–brain barrier opening in swine

Journal of Magnetic Resonance Imaging — Fri, 30 Sep 2011 04:00:00 +0100

Conclusion:This study provides valuable information regarding the use low‐frequency ultrasound for BBB disruption and suggest that SPIO nanoparticles has the potential to serve as a thernostic agent in MRI‐guided ultrasound‐enhanced brain drug delivery. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc. (Source: Journal of Magnetic Resonance Imaging)

Epidermoid Cysts in the Frontal Lobe – A Case Series

Journal of Pakistan Medical Students — Fri, 30 Sep 2011 04:00:00 +0100

Conclusion Intracranial epidermoid tumors are rarely found in the frontal lobes. Surgical resection appears the mainstay of treatment; however, the extent of resection is dictated by the adherence of the tumor capsule to surrounding vital structures. The advantages of aggressive neurosurgical intervention must be weighed against an acceptable risk of neurological outcomes. Due to indolent growth pattern, subtotal resection is also acceptable. REFERENCES 1. Bailey P. Cruveilhiers tumeur perlees. Surg Gynecol obstet. 1920;31:390-401. 2. Cushing H. A large epidermal cholesteatoma of the parieto-temporal region deforming the left hemisphere without cerebral symptoms. Surg Gynecol obstet. 1922;34:557-66. 3. Berger MS, Wilson CB. Epidermoid cysts o...

Bilateral sciatic neuropathy as a complication of craniotomy performed in the sitting position: localization of nerve injury by using magnetic resonance imaging

Child's Nervous System — Thu, 29 Sep 2011 06:18:00 +0100

Conclusion A heightened awareness of sciatic nerve injury during prolonged surgery in the sitting position may make early diagnosis possible and allow prevention of further neurologic injury. Content Type Journal ArticleCategory Case ReportPages 1-5DOI 10.1007/s00381-011-1597-4Authors Jia-Chi Wang, Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei City, Taiwan 11217, Republic of ChinaTai-Tong Wong, Division of Pediatric Neurosurgery, Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of ChinaHsin-Hung Chen, Division of Pediatric Neurosurgery, Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of ChinaPo-Yao C...

Return-to-Play Decisions

Physical Medicine and Rehabilitation Clinics of North America — Mon, 26 Sep 2011 04:00:00 +0100

This article discusses a comprehensive approach to return to play in sports concussion, including managing athletes returning after prolonged postconcussion syndrome, multiple concussions, and intracranial hematomas and craniotomy. (Source: Physical Medicine and Rehabilitation Clinics of North America)

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En-bloc craniotomy for the pre-sigmoid infra- and supratentorial approach: technical note

Acta Neurochirurgica — Sat, 24 Sep 2011 15:46:59 +0100

Conclusion The en-bloc cranioplastic approach with preservation of the mastoid process is a new, interesting variant of a classical technique that is easy to perform and has the intention of achieving the best possible cosmetic result. Content Type Journal ArticleCategory Technical NotePages 1-6DOI 10.1007/s00701-011-1170-7Authors Carlos Martín Rica, Department of Surgery/Neurosurgery, Faculty of Medicine, University of Buenos Aires, Av. Córdoba 2069. 1° A, Capital Federal C1120AAC, Buenos Aires, ArgentinaDaniel Horacio D’Osvaldo, Department of Surgery/Neurosurgery, Faculty of Medicine, University of Buenos Aires, Av. Pueyrredón 1640, Capital Federal C1118AAT, Buenos Aires, ArgentinaMichael Buchfelder, Department of Neurosurgery, University of Erlangen-Nürnber...

Assessment of cardiac preload status by pulse pressure variation in patients after anesthesia induction: comparison with central venous pressure and initial distribution volume of glucose

Journal of Anesthesia — Wed, 21 Sep 2011 05:55:31 +0100

Conclusion As an indicator of cardiac preload, PPV has a negative linear correlation with IDVG in patients after anesthesia induction. It does not correlate well with CVP in the normal range. Our results imply that an individual PPV, not CVP, is equivalent to IDVG in assessing volume status after induction. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00540-011-1225-1Authors Zhiyong He, Department of Anesthesiology, Huashan Hospital, Fudan University, No. 12 Urumqi Central Rd., 200040 Shanghai, People’s Republic of ChinaHui Qiao, Department of Anesthesiology, Huashan Hospital, Fudan University, No. 12 Urumqi Central Rd., 200040 Shanghai, People’s Republic of ChinaWei Zhou, Department of Anesthesiology, Huashan Hospital, Fudan Univer...

Pituitary tumor apoplexy in patients with Cushing’s disease: endocrinologic and visual outcomes after transsphenoidal surgery

Pituitary — Fri, 16 Sep 2011 16:49:48 +0100

We report four patients with Cushing’s disease harboring ACTH-secreting macroadenomas who presented with pituitary apoplexy. We report the endocrinologic and visual outcomes of these patients after emergent transsphenoidal surgery. A retrospective chart review was performed in 4 patients who presented with pituitary apoplexy from hemorrhage into an ACTH-secreting pituitary adenoma. The patient charts were reviewed for clinical presentation, neuroimaging findings, intraoperative surgical findings, pathologic findings, and postoperative endocrinologic and visual outcomes. All patients presented with acute headaches, nausea, vomiting, and visual loss from optic compression. MR imaging demonstrated a hemorrhagic macroadenoma that was confirmed at surgery. All patients underwent emerge...

Side-Cutting Aspiration Device for Endoscopic and Microscopic Tumor Removal

Skull Base — Fri, 16 Sep 2011 04:00:00 +0100

Skull BaseDOI: 10.1055/s-0031-1287679ABSTRACTThe authors present a unique side-cutting instrument (NICO Myriad, Indianapolis, IN) with variable aspiration designed specifically for tumor resection. The study included retrospective review of data collected from 10/2009 to 01/2011. We detail the use of the Myriad in 31 patients with the following pathologies: meningioma (n = 16), chordoma (n = 3), schwannoma (n = 3), pituitary adenoma (n = 2), metastasis (n = 3), hemangioblastoma (n = 1), craniopharyngioma (n = 1), and nasopharyngeal tumors (n = 2). Surgical approaches included expanded endonasal approach (n = 19), endoscopic brain port (n = 3), supraorbital “eyebrow” craniotomy (n = 3), retrosigmoid suboccipital craniotomy (n = 3), pterion...

The Supraorbital Approach for Recurrent or Residual Suprasellar Tumors

min - Minimally Invasive Neurosurgery — Thu, 15 Sep 2011 04:00:00 +0100

Minim Invasive Neurosurg 2011; 54: 155-161DOI: 10.1055/s-0031-1284401Suprasellar tumors can be removed through a variety of approaches including conventional frontotemporal craniotomies, the transsphenoidal route, or the supraorbital (SO) eyebrow craniotomy. Herein we assess the utility of the SO route for recurrent or residual suprasellar tumors previously treated by an alternative route.A retrospective analysis of all consecutive patients who underwent an SO approach for removal of a recurrent/residual tumor was undertaken.Between December 2007 and February 2010, 11 patients underwent an SO craniotomy for a recurrent or growing residual tuberculum sellae meningioma (n=7) or craniopharyngioma (n=4). All 11 patients had prior craniotomies, 5 had transsphenoidal surgery, 6 had radiation tre...

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Precocious subdural haematoma

Emergency Medicine Journal — Wed, 14 Sep 2011 04:00:00 +0100

A 94-year-old man with deterioration to decerebrate posturing (GCS 4) with 3 mm unreactive pupils had CT head imaging (figure 1A) 7 h after a fall. It was decided not to perform a craniotomy given poor neurological prognosis. Figure 1A alone might be interpreted as acute on chronic subdural haematoma. However, a previous unremarkable CT 2 days earlier (figure 1B) suggests that the bleeding was acute/hyperacute, and may have decanted into hyperdense proteinaceous clotting plasma and hypodense extravasated unclotted serum. Such heterogeneous density is known as a ‘swirl’ sign in extradural haematomas,1 but has a deceptively layered and unswirled appearance here, suggesting that it might have mixed with cerebrospinal fluid to form a haematohygroma after trauma to un...

The surgical management of chronic subdural hematoma

Urosurgical Review — Fri, 09 Sep 2011 16:46:48 +0100

Abstract Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: “subdural hematoma”, “craniotomy”, “burr-hole”, “managemen...

Communicating hydrocephalus following surgery and adjuvant radiochemotherapy for glioblastoma.

Journal of Neurosurgery — Fri, 09 Sep 2011 04:00:00 +0100

Conclusions Ventricular opening after radiochemotherapy and high CSF protein levels are significant predictors of communicating hydrocephalus in patients with GBM. The VP shunt surgery improves quality of life in these patients. PMID: 21905801 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

Age Not a Contraindication to Craniotomy for Hematoma Age Not a Contraindication to Craniotomy for Hematoma

Medscape Neurology and Neurosurgery Headlines — Thu, 08 Sep 2011 21:26:00 +0100

A study shows that octogenarians can achieve good outcomes after craniotomy to remove hematoma, although they may take longer to recover than younger patients. Medscape Medical News (Source: Medscape Neurology and Neurosurgery Headlines)

[Nasal dermoïd cyst with intracranial extension: Which approach?]

Neuro-Chirurgie — Mon, 05 Sep 2011 04:00:00 +0100

We report a case of a 2 years old patient who was operated for a nasal congenital cyst extending to the nasal septum. Anatomopathology showed a dermoïd cyst. Five years later, he presented local recurrence of the dermoïd cyst with intracranial extension through a bifid crista galli. We conclude that to avoid recurrence, the removal of the nasal cyst and sinus tract must be followed to its dural attachment. A transfacial approach can be associated with frontal craniotomy, which can provide adequate exposure for complete removal of the intracranial component of the cyst and sinus tract. A literature review was performed. PMID: 21899863 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)

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Is postoperative intensive care unit admission a prerequisite for elective craniotomy?

Journal of Neurosurgery — Fri, 02 Sep 2011 04:00:00 +0100

Conclusions Routine ward admission for patients undergoing elective craniotomies with selective ICU admission appears safe; however, approximately 2% of patients may require a direct postoperative unplanned ICU admission. Patients with anticipated long operation times, extensive blood loss, and high anesthetic risks should be selected for postoperative ICU admission, but further study is needed to determine the preoperative factors that can aid in identifying and caring for these groups of patients. PMID: 21888476 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

Lower extremity complex regional pain syndrome type II after a craniotomy: case report

Journal of Clinical Anesthesia — Thu, 01 Sep 2011 04:00:00 +0100

Abstract: Complex regional pain syndrome (CRPS) is a collection of signs and symptoms that most often include regional pain, edema, changes in skin temperature, increased skin sensitivity, and weakness that usually affects the extremities. It almost always exclusively affects the surgical site. A 52 year old woman presented with lower extremity CRPS due to positioning after a craniotomy. (Source: Journal of Clinical Anesthesia)

Craniotomy for brain metastases: a consecutive series of 316 patients

Acta Neurologica Scandinavica — Thu, 01 Sep 2011 04:00:00 +0100

Conclusions – In this population study, the annual incidence of a first‐time craniotomy for a brain metastasis was 2.6/100,000, the 30‐day mortality rate was 3.8%, and median OS was 9.2 months. The well‐known prognostic factors were confirmed. (Source: Acta Neurologica Scandinavica)

S719 scalp nerve block: does it decrease postoperative pain after craniotomy?

European Journal of Pain Supplements — Thu, 01 Sep 2011 04:00:00 +0100

(Source: European Journal of Pain Supplements)

Osteolytic skull metastasis with dural involvement from a papillary thyroid carcinoma.

Collegium Antropologicum — Thu, 01 Sep 2011 04:00:00 +0100

We report a case of a 76-year-old woman who presented with a bulging, well-circumscribed mass on the right side of the forehead. Neuroimaging of the cranium detected an osteolytic lesion measuring 7 cm in the largest diameter while propagating outwards and intracranially. A thorough medical history revealed that patient had undergone surgery for invasive breast ductal carcinoma and also for a well-differentiated thyroid carcinoma 13 years ago. Considering patients medical history metastatic breast carcinoma was suspected. After a frontal craniotomy the tumour tissue was totally resected. Histological examination revealed metastatic papillary carcinoma characterized by ground-glass nuclei with intranuclear pseudo inclusion and nuclear grooves. We report clinical and neuroradiological featur...

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Endoscopic management of cerebrospinal fluid rhinorrhea

Operative Techniques in Otolaryngology - Head and Neck Surgery — Thu, 01 Sep 2011 04:00:00 +0100

The surgical management of cerebrospinal fluid (CSF) rhinorrhea has evolved with advances in technology and experience with endoscopic endonasal approaches to skull base lesions. The endonasal approach provides excellent visualization and access for repair of CSF leaks and obviates the need for a craniotomy. Over the last 20 years the endoscopic endonasal technique has been refined to provide CSF leak closure rates consistently higher than 90%. In this article, we describe our technique for closure of CSF leaks along the anterior skull base via an endoscopic endonasal approach. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)

Postoperative respiratory depression with pregabalin: A case series and a preoperative decision algorithm.

Pain Research and Management — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Eipe N, Penning J Abstract Pregabalin is gaining popularity in the perioperative period for its usefulness in treating neuropathic pain and its apparent opioid- sparing effect. The present report describes the perioperative course of three patients who received pregabalin and experienced significant respiratory depression in the postoperative period. All three patients consented to the report and publication of the present case series. The first patient was elderly with borderline renal dysfunction. She experienced respiratory arrest in the immediate postoperative period following a craniotomy for tumour excision. The second patient presented with severe respiratory depression 12 h after receiving a spinal anesthetic for joint replacement, and was later found to have clini...

Efficancy of decompressive craniectomy in treatment of severe brain injury at the Rijeka University Hospital Centre.

Collegium Antropologicum — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Girotto D, Ledić D, Bajek G, Jerković R, Dragicević S Abstract Decompressive Craniectomy (DC) is a treatment option for severe brain injury (SBI). This method is applied when the growth of intracranial pressure (ICP) can no longer be controlled with conservative methods. DC belongs to class III "Guidelines"--"option" which has not clear clinical certainty. They do not correspond to "Standards" (class I) in treatment protocol for SBI, which is common in most neurotraumatological centers. We have analyzed retrospectively 95 patients with SBI who were admitted to the Clinical Hospital Centre Rijeka. All patients were managed based on a protocol of current Brain Trauma Foundations (BTF) Guidelines. 39 patients underwent DC while 34 patients underwent standard craniotomy. 22...

Onyx HD-500 Liquid Embolic Agent for the Embolization of Broad-Based Saccular Intracranial Aneurysms: A Case Study

Journal of Radiology Nursing — Wed, 31 Aug 2011 23:00:00 +0100

Abstract: Over the years, many different techniques have been used to treat brain aneurysms. Traditionally, open surgery or craniotomy was required for aneurysm clipping, but since the mid 1980s the endovascular treatment of aneurysms has become increasingly popular. The mainstay of endovascular aneurysm treatment has been embolization with platinum coils (a.k.a. “coiling”). However, despite advances in endovascular techniques, such as balloon remodeling and intracranial stent placement, it remains difficult to achieve the complete and permanent occlusion of many broad-based saccular aneurysms. Onyx HD-500 (eV3 Neurovascular, Irvine, CA), a liquid embolic agent, is the latest Food and Drug Association-approved device to be used in attempt to overcome the challenge of occluding broad-ba...

Tracheal tube kinking during craniotomy in supine position after application of fish hook retractors

Neurology India — Mon, 29 Aug 2011 23:00:00 +0100

Surya Kumar Dube, Girija Prasad Rath, Nidhi Gupta, Navdeep SokhalNeurology India 2011 59(4):647-648 (Source: Neurology India)

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Brain metastasis from stage I esophageal squamous cell carcinoma after surgery: a case report

Esophagus — Mon, 29 Aug 2011 16:00:07 +0100

Abstract Esophageal cancer rarely metastasizes to the brain. The authors experienced a case of esophageal carcinoma which metastasized to the cerebellum as the first presentation. A 61-year-old man was identified as having esophageal carcinoma by esophagogastroduodenoscopy during a medical checkup. Subtotal esophagectomy with dissection of 3 regional lymph nodes was performed. The tumor was 30 × 20 mm2 in size, and was revealed to be a moderately differentiated squamous cell carcinoma. The pathological finding was T1b(SM)N0M0 stage I. Fourteen months after the surgery, the patient complained of nausea. Brain magnetic resonance imaging (MRI) showed a cystic tumor of 42 × 28 × 28 mm3 in size in the central cerebellum. No other me...

The breach rhythm

Clinical Neurophysiology — Mon, 29 Aug 2011 04:00:00 +0100

Highlights: ► EEG after craniotomy are difficult to interpret because of breach rhythm. ► Breach rhythm can mimic epileptiform abnormalities and lead to misinterpretations. ► Breach rhythm appears to have a little relationship to epilepsy. ► In an EEG with breach rhythm, it is very important to adopt a ‘conservative’ reading.Abstract: Electroencephalography (EEG) recordings obtained after craniotomy are difficult to interpret because of the presence of a breach rhythm (BR) consisting of unfiltered high-voltage physiological waveforms, sometimes with a spiky and irregular morphology, that can mimic interictal epileptiform abnormalities and may therefore lead to misinterpretations. In this article, we review EEG features of BR and give some technical tips to properly interpret BR...

Cyst Formation Following Radiosurgery for AVMs: Report of 3 Cases.

The Canadian Journal of Neurological Sciences — Sat, 27 Aug 2011 16:17:09 +0100

Conclusion: Stereotactic radiosurgery is an established and safe treatment for patients with AVMs. Delayed cyst formation can occur many years after treatment and long term follow-up is indicated in patients whose AVM has been treated with SRS. PMID: 21856577 [PubMed - in process] (Source: The Canadian Journal of Neurological Sciences)

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years.

Journal of Neurosurgery — Fri, 26 Aug 2011 04:00:00 +0100

Conclusions The findings suggest that in comparison with younger patients, patients over 80 years of age may be similarly able to return to preinjury functional baselines but may require increased postoperative medical attention in the forms of rehabilitation and longer hospital stays. Prospective studies concerned with the relation between older age, perioperative parameters, and postoperative outcomes following craniotomy for intracranial hemorrhage are needed. Nonetheless, the findings of this study may allow for more informed decisions with respect to the care of elderly patients with intracranial hemorrhage. PMID: 21888477 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

Microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm: Naunces of the technique based on experiences with 100 patients and review of the literature

Clinical Neurology and Neurosurgery — Fri, 26 Aug 2011 04:00:00 +0100

Conclusion: In the presence of alternative methods of therapy, microvascular decompression operations should be performed with low risk to the patient. There is a learning curve involved with this operation and the surgeon should remain always critical of his/her performance and aspire for a “perfect” result. (Source: Clinical Neurology and Neurosurgery)

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Patient acceptance of awake craniotomy

Clinical Neurology and Neurosurgery — Fri, 26 Aug 2011 04:00:00 +0100

Conclusion: Previous studies have shown good patients’ acceptance for awake craniotomy, but only a few times using formal approaches. By utilizing a formal questionnaire we could verify good patient acceptance for awake craniotomy for the treatment of brain tumors in or close to eloquent areas. This is a novel approach that substantiates previously published experiences. (Source: Clinical Neurology and Neurosurgery)

Preoperative MRI/MRA for microvascular decompression in trigeminal neuralgia: consecutive series of 67 patients

Acta Neurochirurgica — Thu, 25 Aug 2011 05:45:46 +0100

Conclusions Preoperative MRI has both good sensitivity and positive predictive value. Specificity and negative predicitve value were limited in this series. No correlation was found between preoperative imaging and outcome. Both radiological and clinical criteria are important for patient selection. Content Type Journal ArticleCategory Clinical ArticlePages 1-6DOI 10.1007/s00701-011-1135-xAuthors Francesco Vergani, Department of Neurosurgery, Royal Victoria Infirmary, Queen Victoria road, Newcastle Upon Tyne, UKProkopios Panaretos, Department of Neurosurgery, Royal Victoria Infirmary, Queen Victoria road, Newcastle Upon Tyne, UKAlvin Penalosa, Department of Neurosurgery, Royal Victoria Infirmary, Queen Victoria road, Newcastle Upon Tyne, UKPhilip English, Neuroradio...

Osteoplastic decompressive craniotomy—an alternative to decompressive craniectomy

Acta Neurochirurgica — Thu, 25 Aug 2011 05:45:45 +0100

Conclusion Our limited study shows that ODC is effective in the treatment of intracranial hypertension in the selected subgroup of patients in whom DC would be too radical. The main advantage of this method is the elimination of further cranioplasty. Content Type Journal ArticleCategory Technical NotePages 1-5DOI 10.1007/s00701-011-1132-0Authors Jan Mracek, Department of Neurosurgery, Charles University Hospital and Faculty of Medicine in Pilsen, Alej Svobody 80, Pilsen, 304 60 Czech RepublicMilan Choc, Department of Neurosurgery, Charles University Hospital and Faculty of Medicine in Pilsen, Alej Svobody 80, Pilsen, 304 60 Czech RepublicJan Mork, Department of Neurosurgery, Charles University Hospital and Faculty of Medicine in Pilsen, Alej Svobody 80, Pilsen, 304 6...

The breach rhythm.

Clinical Neurophysiology — Wed, 24 Aug 2011 23:00:00 +0100

Authors: Brigo F, Cicero R, Fiaschi A, Bongiovanni LG Abstract Electroencephalography (EEG) recordings obtained after craniotomy are difficult to interpret because of the presence of a breach rhythm (BR) consisting of unfiltered high-voltage physiological waveforms, sometimes with a spiky and irregular morphology, that can mimic interictal epileptiform abnormalities and may therefore lead to misinterpretations. In this article, we review EEG features of BR and give some technical tips to properly interpret BR and to make a correct differential diagnosis with epileptiform abnormalities. As BR itself has no relationship to epilepsy, it is very important to adopt a "conservative" reading, having a high threshold to call epileptiform abnormalities. PMID: 21872525 [PubMed - as suppl...

Magnetic resonance velocity mapping of 3D cerebrospinal fluid flow dynamics in hydrocephalus: preliminary results

European Radiology — Wed, 24 Aug 2011 07:20:19 +0100

Conclusions Our approach may be useful for diagnosis, therapy planning, and follow-up of different kinds of hydrocephalus. Key Points • Velocity-mapping provides additional information about CSF flow compared to 2D phase-contrast MRI • Ventricular CSF flow of hydrocephalus patients and volunteers shows complex 3D dynamics • This technique may be useful for the management of patients with hydrocephalus • The pathophysiological basis of CSF flow dysfunction may be better understood Content Type Journal ArticleCategory NeuroPages 1-11DOI 10.1007/s00330-011-2247-7Authors Andreas Stadlbauer, MR Physics Group, Department of Radiology, Landesklinikum St. Poelten, Propst Fuehrer Strasse 4, 3100 St. Poelten, AustriaEri...

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The Effect of Lipid Emulsion Infusion on Postmortem Ropivacaine Concentrations in Swine: Endeavoring to Comprehend a Soldier's Death.

Anesthesia and Analgesia — Tue, 23 Aug 2011 23:00:00 +0100

Conclusions: Our data show that postmortem blood samples in swine that experience local anesthetic cardiovascular collapse and are treated with lipid emulsions will result in measurements that cannot be directly extrapolated to premortem drug concentrations. PMID: 21865498 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

Antiepileptic drugs for treating seizures in adults with brain tumours.

Cochrane Database of Systematic Reviews — Sat, 20 Aug 2011 17:00:05 +0100

CONCLUSIONS: There is a lack of robust, randomised, controlled evidence to support the choice of antiepileptic drug for the treatment of seizures in adults with brain tumours. While some authors support the use of non enzyme-inducing antiepileptic drugs, reliable, comparative evidence to provide clinical justification for this is limited. There is a need for further large, randomised, controlled trials in this area. PMID: 21833969 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Computed tomography findings in cerebral hydatid disease.

Turkish Neurosurgery — Fri, 19 Aug 2011 22:22:04 +0100

CONCLUSION: Accurate preoperative diagnosis of cerebral hydatid by CT followed by surgery with care to avoid cyst rupture can result in favorable outcome. PMID: 21845570 [PubMed - in process] (Source: Turkish Neurosurgery)

Analysis of the mortality probability of preoperative MRI features in malignant astrocytomas.

Turkish Neurosurgery — Fri, 19 Aug 2011 22:22:04 +0100

CONCLUSION: Necrosis in preoperative MRI of malignant astrocytomas seems to be an important clinical marker of the prognosis. PMID: 21845561 [PubMed - in process] (Source: Turkish Neurosurgery)

Pseudoaneurysm of the superficial temporal artery following revision of a middle cerebral artery aneurysm clipping: case report and review of the literature.

Turkish Neurosurgery — Fri, 19 Aug 2011 22:22:03 +0100

In conclusion, pseudoaneurysm of the superficial temporal artery should be considered among the early postoperative complications of the surgical procedures at the superficial temporal artery territory. Although some conservative approaches are used, excision of the aneurysm is recommended for treatment. PMID: 21845586 [PubMed - in process] (Source: Turkish Neurosurgery)

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Cerebral tuberculoma mimicking high grade glial tumor.

Turkish Neurosurgery — Fri, 19 Aug 2011 22:22:03 +0100

We present a case of tuberculoma mimicking a high grade glial tumor on magnetic resonance imaging and clinical presentation. A 30-year-old woman presented with one-month history of epilepsy. Cranial magnetic resonance imaging showed a left occipital peripheral ring-enhanced lesion with central necrosis. There was a strong suspicion of glial tumor. The lesion was totally excised with left occipital craniotomy. Histological examination of mass revealed a tuberculoma. The patient was treated with antituberculous chemotherapy. PMID: 21845585 [PubMed - in process] (Source: Turkish Neurosurgery)

Flexible-fiber CO2 Laser Proves Safe In Endoscopic Endonasal Transsphenoidal Surgery

Health News from Medical News Today — Thu, 18 Aug 2011 08:00:00 +0100

A new study has shown the Flexible-Fiber CO2 laser to safely cut and coagulate during endoscopic assisted transsphenoidal craniotomies (TSC) without the line of sight problems encountered with conventional CO2 lasers. The findings, reported by researchers from Boston Medical Center (BMC) and Boston University School of Medicine (BUSM), appear in the July/August issue of World Neurosurgery. This is the first study to report the utility of flexible-fiber CO2 laser-assisted ablation in TSC... (Source: Health News from Medical News Today)

Study finds flexible-fiber CO2 laser safe in endoscopic endonasal transsphenoidal surgery

EurekAlert! - Medicine and Health — Tue, 16 Aug 2011 04:00:00 +0100

(Boston University Medical Center) A new study has shown the Flexible-Fiber CO2 laser to safely cut and coagulate during endoscopic assisted transsphenoidal craniotomies without the line of sight problems encountered with conventional CO2 lasers. The findings, reported by researchers from Boston Medical Center and Boston University School of Medicine, appear in the July/August issue of World Neurosurgery. This is the first study to report the utility of flexible-fiber CO2 laser-assisted ablation in TSC. (Source: EurekAlert! - Medicine and Health)

Spatio‐temporal responses in the visual cortex evoked from first‐ and higher order thalamic nuclei in tree shrews: a voltage sensitive dyes study

Acta Ophthalmologica — Sat, 13 Aug 2011 09:27:06 +0100

Conclusion The pulvinar can exert a modulator influence in cortical processing of LGN inputs while it mainly provides driver inputs to XC. (Source: Acta Ophthalmologica)

Combined craniofacial approach for the removal of a large trigeminal schwannoma invading the infratemporal fossa

Oral and Maxillofacial Surgery — Sat, 13 Aug 2011 06:13:57 +0100

We describe a case of a 69-year-old woman with a history of progressively worsening hypoesthesia involving the third division of the trigeminal nerve. A tumour of 5-cm diameter was revealed within the right cranial middle fossa, extending to the lateral wall of the cavernous sinus, the infratemporal fossa and the posterior wall of the maxillary sinus. A combined craniofacial approach was undertaken. A right extended subtemporal craniotomy was performed. The intracranial component of the tumour, originating from the third division of the trigeminal nerve and compressing the cavernous sinus, was removed in total. We proceeded with a Weber–Ferguson approach through which the extracranial component of the tumour was also totally resected. The postoperative computed tomography of the he...

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[Comparison of the lesion produced by permanent focal cerebral ischaemia in three animal models using magnetic resonance imaging].

Revista de Neurologia — Fri, 12 Aug 2011 07:00:49 +0100

DISCUSSION. The intraluminal occlusion of the MCA model, although yields in the highest mortality rate (28%), it is the more suitable for long term studies, mainly because of the absence of craniotomy. In the electrocoagulation model a non ischemic lesion region is observed which leads to an abnormal lesion evolution as compared with the other two models. PMID: 21796604 [PubMed - in process] (Source: Revista de Neurologia)

Effect of intravenous parecoxib on post-craniotomy pain

British Journal of Anaesthesia — Thu, 11 Aug 2011 23:00:00 +0100

Conclusions Our study demonstrated no clinical benefit to adding i.v. parecoxib to local anaesthetic scalp infiltration, i.v. paracetamol, and patient-controlled i.v. morphine after supratentorial craniotomy. Trial Registration: ClinicalTrials.gov registry NCT00455117; Australian Clinical Trials Registry ACTRN12605000600640 (Source: British Journal of Anaesthesia)

Nationwide investigation of the current status of therapeutic neuroendoscopy for ventricular and paraventricular tumors in Japan.

Journal of Neurosurgery — Thu, 11 Aug 2011 23:00:00 +0100

Conclusions The authors concluded that neuroendoscopic diagnosis using biopsy for ventricular and paraventricular tumors is adequately accurate and safe. It was demonstrated that endoscopic procedures play important roles not only in the treatment of hydrocephalus associated with intra- and paraventricular tumors but also in significantly improving ADL. Furthermore, the long-term outcome of endoscopic third ventriculostomy was clearly favorable. PMID: 21838511 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

Glioblastoma Multiforme in Children: Report of 13 Cases and Review of the Literature

Pediatric Neurology — Wed, 10 Aug 2011 22:18:47 +0100

We present clinical and histopathologic data from 13 children who underwent craniotomy for newly diagnosed glioblastoma multiforme. Clinical characteristics were compared to those in adult patients (n = 403). The mean age of the children was 10.4 years. The male/female ratio was 3.3:1. The localization was infratentorial in 6 cases (brainstem, n = 4; cerebellum, n = 2) and supratentorial in 7 cases (frontal, n = 2; parietal, n = 3; temporal, n = 2). Infratentorial localization was observed solely in children from 0–10 years, whereas supratentorial location was found in children between the age of 11 and 21 years. Surgical resection was followed by radiotherapy in 11 cases and additional chemotherapy in 8 cases. Giant cell glioblastoma multiforme was found in 2 cases (15%, vs 1–5%...

Prolonged triple therapy for persistent multidrug-resistant Acinetobacter baumannii ventriculitis.

American Journal of Health-System Pharmacy : AJHP — Wed, 10 Aug 2011 16:30:24 +0100

Conclusion Prolonged combination therapy with intraventricular colistin and tobramycin plus i.v. colistin, rifampin, and vancomycin led to the resolution of a persistent central nervous system infection caused by MDR A. baumannii. PMID: 21817084 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

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Cerebral Salt Wasting Syndrome in Post-Operative Pediatric Brain Tumor Patients

Neurocritical Care — Sat, 06 Aug 2011 05:55:25 +0100

Conclusion The diagnosis of CSWS should be strongly considered in hyponatremic pediatric patients with significant natriuresis following brain tumor resection, and a treatment initiated promptly to prevent neurologic sequeleae. Content Type Journal ArticlePages 1-6DOI 10.1007/s12028-011-9618-4Authors Douglas A. Hardesty, Department of Neurosurgery, Children’s Hospital of Philadelphia and University of Pennsylvania Medical Center, Wood Center, 6th Floor, 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399, USATodd J. Kilbaugh, Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA, USAPhillip B. Storm, Department of Neurosurgery, Children’s Hospital...

The fully endoscopic supraorbital trans-eyebrow keyhole approach to the anterior and middle skull base

Acta Neurochirurgica — Fri, 05 Aug 2011 06:00:02 +0100

Conclusion The purely endoscopic eyebrow supraorbital keyhole approach is a valuable and alternative minimally invasive route to anterior and middle skull base lesions. Content Type Journal ArticlePages 1-6DOI 10.1007/s00701-011-1089-zAuthors Moncef Berhouma, Skull Base Surgery Unit, Department of Neurosurgery A, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, FranceTimothée Jacquesson, Skull Base Surgery Unit, Department of Neurosurgery A, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, FranceEmmanuel Jouanneau, Skull Base Surgery Unit, Department of Neurosurgery A, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France Journal Acta Neurochirurgi...

Immune Cell Populations Decrease During Craniotomy Under General Anesthesia.

Anesthesia and Analgesia — Tue, 02 Aug 2011 23:00:00 +0100

Conclusion: Our results showed that anesthesia and surgery upset the balance of the immune system during craniotomy, and a significant decrease in immune cell populations emerged after induction under general anesthesia. PMID: 21813628 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

Tuberculum Sella Meningioma

Otolaryngologic clinics of North America — Sun, 31 Jul 2011 23:00:00 +0100

Tuberculum sellae (TS) meningiomas represent a distinct subgroup of anterior cranial fossa meningiomas with distinctive features. Early visual deterioration with optic canal infiltration occurs because of the site of dural origin. The expanded endonasal transsphenoidal approach and the eyebrow supraorbital craniotomy have been advocated as minimally invasive techniques for TS meningiomas. The authors review the current literature on minimally invasive techniques for TS meningiomas to define visual outcomes, extent of resection, and operative morbidity associated with each approach and highlight pertinent features of individual tumors, which favor either a cranial or an endonasal approach to achieve optimal outcomes. (Source: Otolaryngologic clinics of North America)

Intracranial hypertension in 2 cases of craniometaphyseal dysplasia: differing surgical options.

Neurosurgical Focus — Sun, 31 Jul 2011 23:00:00 +0100

Authors: Rivero-Garvía M, Márquez-Rivas FJ, García-Iglesias A, Gutiérrez-González R Craniometaphyseal dysplasia (CMD) is a very rare bone disorder characterized by abnormally developed metaphyses in long bones and sclerosis of the craniofacial bones. In this paper, the authors report 2 cases of children diagnosed with CMD and chronic intracranial hypertension with deletion in exon 9 of the human ANK gene (ANKH). After intracranial monitoring, a different treatment was chosen for each patient. One of the patients was treated using CSF shunting because ventriculomegaly in the absence of a Chiari malformation was also observed on cerebral MR imaging. The other patient underwent cranial expansion and decompressive craniotomy of the posterior fossa, because ventriculomegaly was exclude...

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Histological and radiological changes in cranial bone in the presence of bone wax.

Acta Cirurgica Brasileira — Sun, 31 Jul 2011 23:00:00 +0100

Authors: Raposo-Amaral CE, Almeida AB, Paschoal G, Bueno DF, Vulcano LC, Passos-Bueno MR, Alonso N To quantify the amount of bone formation in the calvarial region of Wistar rats after craniotomy using bone wax as a haemostatic agent. PMID: 21808839 [PubMed - in process] (Source: Acta Cirurgica Brasileira)

Epidemiology of pediatric cardiac injuries: a National Trauma Data Bank analysis

Journal of Pediatric Surgery — Sun, 31 Jul 2011 23:00:00 +0100

Conclusions: The predominant cardiac injury was blunt (65%; 35% sustained penetrating insults), frequently paired with contusion. Pediatric cardiac injury is associated with excessive inhospital mortality (40%), with no age-related difference in adjusted mortality. (Source: Journal of Pediatric Surgery)

Craniotomy repair with the retrosigmoid approach: the impact on quality of life of meticulous reconstruction of anatomical layers

Acta Neurochirurgica — Sun, 31 Jul 2011 05:41:27 +0100

Discussion and conclusions We observed a statistically significant reduced incidence of local discomfort, postoperative headache and CSF leak in patients who underwent such a reconstructive technique compared to those undergoing retrosigmoid craniectomy. Content Type Journal ArticlePages 1-4DOI 10.1007/s00701-011-1113-3Authors Giuseppe Maria Della Pepa, Institute of Neurosurgery, Department of Functional Neurosurgery, Catholic University of Rome, L.go A. Gemelli 8, 00168 Rome, ItalyNicola Montano, Institute of Neurosurgery, Department of Functional Neurosurgery, Catholic University of Rome, L.go A. Gemelli 8, 00168 Rome, ItalyCorrado Lucantoni, Institute of Neurosurgery, Department of Functional Neurosurgery, Catholic University of Rome, L.go A. Gemelli 8, 00168 Rome...

Operative treatment for microcephaly secondary to craniosynostosis at the turn of the twentieth century

Child's Nervous System — Tue, 26 Jul 2011 15:48:10 +0100

Conclusions Although Cushing published his disapproval of the use of craniotomies in the treatment of microcephaly in 1908, a review of his early surgical files demonstrates that this opinion was based on cases published in the literature, rather than his own operative experience. In 1911, he performed bilateral craniotomies in a 3-year-old patient with microcephaly and documented post-operative improvement in the patient’s general condition. Content Type Journal ArticlePages 1-4DOI 10.1007/s00381-011-1531-9Authors Jose Undabeitia, Department of Neurosurgery, Cruces Hospital, Barakaldo, Vizcaya, SpainCourtney Pendleton, Brain Tumor Stem Cell Laboratory, Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research...

Study Finds Flexible-fiber CO2 Laser Safe in Endoscopic Endonasal Transsphenoidal Surgery

Boston University News Releases — Mon, 25 Jul 2011 18:19:38 +0100

(Boston) – A new study has shown the Flexible-Fiber CO2 laser to safely cut and coagulate during endoscopic assisted transsphenoidal craniotomies (TSC) without the line of sight problems encountered with conventional CO2 lasers. The findings, reported by researchers from Boston Medical Center (BMC) and Boston University School of Medicine (BUSM), appear in the July/August issue of World Neurosurgery. This is the first study to report the utility of flexible-fiber CO2 laser-assisted ablation in TSC. (Source: Boston University News Releases)

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Grade II oligodendroglioma localized to the corpus callosum

Brain Tumor Pathology — Thu, 21 Jul 2011 18:16:55 +0100

We present, to our knowledge, the first report of a grade II oligodendroglioma isolated within the corpus callosum with the characteristic molecular features of this tumor type. Histopathologic diagnosis is essential to appropriately guide therapy of callosal tumors. Content Type Journal ArticlePages 1-5DOI 10.1007/s10014-011-0054-0Authors Edward A. Monaco, Department of Neurological Surgery, UPMC Presbyterian, University of Pittsburgh Medical Center, Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USAHenry B. Armah, Harper Hospital Pathology, Detroit Medical Center, Detroit, MI, USAMarina N. Nikiforova, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USARonald L. Hamilton, Department of Pathology, University of Pittsburgh Medical Center, P...

Microsurgical resection of deep-seated lesions using transparent tubular retractor: pediatric case series

Child's Nervous System — Thu, 21 Jul 2011 17:56:38 +0100

Conclusion Microsurgery using a transparent tubular retractor guided by a neuronavigation system facilitated accurate and effective removal of these deep-seated brain lesions. Content Type Journal ArticlePages 1-6DOI 10.1007/s00381-011-1529-3Authors Kyung-Il Jo, Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul, South KoreaSang Bong Chung, Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul, South KoreaKwang-Wook Jo, Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul, South KoreaDoo-Sik Kong, Department of Neurosu...

Repositioning of Cranial Bone Flaps Cut with a Diamond-Coated Threadwire Saw: 5-Year Experience with Cosmetic Cranioplasty without Fixation Devices

Skull Base — Wed, 20 Jul 2011 23:00:00 +0100

Skull BaseDOI: 10.1055/s-0031-1284214ABSTRACTArtificial fixation systems for cranial bone flaps have problems related to their materials and designs. We developed an alternative technique for supratentorial craniotomy that employs a diamond-coated threadwire saw (diamond T-saw), originally developed for spinal surgery, and reduces the bone gap for fitted bone flap fixation. The study subjects were 77 adults undergoing elective supratentorial craniotomy. After placing a burr hole at each corner of the craniotomy, we performed osteotomy between adjacent burr holes to approximately one-third of the length of the osteotomy with a craniotome; this leaves a bony bridge at each corner. The diamond T-saw was introduced between adjacent burr holes through the epidural space and a bridge was cut wit...

Texas Children's Hospital Pioneers Use Of MRI-guided Laser Surgery For Revolutionary New Epilepsy Treatment

Health News from Medical News Today — Tue, 19 Jul 2011 08:00:00 +0100

Texas Children's Hospital is the first hospital in the world to use real-time MRI-guided thermal imaging and laser technology to destroy lesions in the brain that cause epilepsy and uncontrollable seizures. According to hospital experts, this new surgical approach offers a safer and significantly less invasive alternative to craniotomy, currently the most commonly used cranial surgical treatment for epilepsy... (Source: Health News from Medical News Today)

Recognising phenytoin therapy as a cause of thickening of the eyelids and paranasal region

Journal of Plastic, Reconstructive and Aesthetic Surgery — Mon, 18 Jul 2011 04:00:00 +0100

We present a 55 year old female, with gradual painless thickening of her eyelids and nose over several months, who requested aesthetic surgery to correct these changes. One-year prior to this she had undergone a craniotomy and debulking of an olfactory groove meningioma and commenced on prophylactic phenytoin therapy. On examination she was found to have a widened nasal bridge and soft-tissue thickening of the glabellar region and medial canthi. (a). Her paranasal and eyelid thickening was presumed to be phenytoin-related and under the supervision of her neurologist this was tailed off. Six-months after stopping phenytoin her soft-tissue thickening had improved. (b). Bilateral ptosis surgery with upper eyelid blepharoplasty is planned. (Source: Journal of Plastic, Reconstructive and Aesthe...

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Weekend and Night Outcomes in a Statewide Trauma System [Original Article]

Archives of Surgery — Sun, 17 Jul 2011 23:00:00 +0100

Conclusions We demonstrate comparable mortality among injured patients presenting on weeknights vs weekdays and lower mortality among injured patients on weekends vs weekdays. Systems-based solutions of the trauma model are protective against the weekend effect and inform care for other emergency care–sensitive conditions. (Source: Archives of Surgery)

Bubbles in the head: a new method for brain retraction during craniotomy

Acta Neurochirurgica — Thu, 14 Jul 2011 16:48:29 +0100

Conclusion Diverting the brain from operative view with a more elastic, less traumatic, and easily adjustable Fogarty catheter balloon tip is a safe and effective tool that can either act as a substitute for SRR or alternatively minimise their duration of use. Content Type Journal ArticlePages 1-5DOI 10.1007/s00701-011-1085-3Authors Giannantonio Spena, Division of Neurosurgery, Civil Hospital, via Venezia 16, 15100 Alessandria, ItalyPietro Versari, Division of Neurosurgery, Civil Hospital, via Venezia 16, 15100 Alessandria, Italy Journal Acta NeurochirurgicaOnline ISSN 0942-0940Print ISSN 0001-6268 (Source: Acta Neurochirurgica)

Multiple Dural Tuberculomas Presenting as Leptomeningeal Carcinomatosis

Clinical and Developmental Immunology — Wed, 13 Jul 2011 13:58:16 +0100

Conclusion. To the best of our knowledge isolated diffuse involvement of the dura mater by TB, mimicking leptomeningeal carcinomatosis, as the sole manifestation of disease has not been reported before. Since pachymeningeal TB is rarely suspected when atypical radiological appearance is combined with the absence of systemic disease, biopsy is inevitably required for diagnosis. (Source: Clinical and Developmental Immunology)

Surgical resection of pulmonary metastases from meningioma: Report of a case

Surgery Today — Tue, 12 Jul 2011 06:14:02 +0100

Abstract Meningiomas rarely metastasize, and little information on pulmonary metastasectomy from meningioma has been documented. We herein report a case of a potentially curative resection for meningioma that metastasized to the lung. A 67-year-old woman was admitted to our hospital because of two masses in the right lung. In 1993, when the patient was 52 years old, she underwent a craniotomy for an atypical meningioma. The meningioma recurred once in the local site and was re-excised in 1997. In 2008, a screening chest X-ray detected two lung nodules in the right lung field. A computed tomographic scan demonstrated round masses with sharp borders, in the right S2 (2.2 cm in diameter) and S4 (1.1 cm in diameter) regions. A whole-body [18F]2-fluoro-2-deoxy-d-glucose (FDG) po...

Transient bilateral brainstem dysfunction caused by topical administration of papaverine.

Journal of Neurosurgery — Thu, 30 Jun 2011 23:00:00 +0100

Authors: Moran CM, Mahla ME, Reichwage B, Lewis S, Peters K, Seubert CN Papaverine has been associated with transient cranial nerve dysfunction after topical application during craniotomy. The authors report similar dysfunction after the use of papaverine affected brainstem structures. Two patients undergoing craniotomy for clipping of an aneurysm experienced bilateral depression of cortical somatosensory evoked potentials to both median and tibial nerve stimulation after administration of papaverine. Arterial blood gas analysis, hemodynamic parameters, and anesthetic levels remained constant throughout these somatosensory evoked potential changes. In addition, intraoperative angiography and immediate postoperative CT imaging showed intact blood flow with complete exclusion of the aneu...

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Neurosurgery and shaving: what's the evidence?

Journal of Neurosurgery — Thu, 30 Jun 2011 23:00:00 +0100

Authors: Broekman ML, van Beijnum J, Peul WC, Regli L Many neurosurgeons remove their patients' hair before surgery. They claim that this practice reduces the chance of postoperative surgical site infections, and facilitates planning, attachment of the drapes, and closure. However, most patients dread this procedure. The authors performed the first systematic review on shaving before neurosurgical procedures to investigate whether this commonly performed procedure is based on evidence. They systematically reviewed the literature on wound infections following different shaving strategies. Data on the type of surgery, surgeryrelated infections, preoperative shaving policy, decontamination protocols, and perioperative antibiotics protocols were collected. The search detected 165 articles,...

Remote cerebellar hemorrhage.

Archives of Iranian Medicine — Thu, 30 Jun 2011 23:00:00 +0100

We report a patient who underwent craniotomy for removal of meningioma. The hemorrhage manifested a few days postoperatively as a headache and transient loss of consciousness. Our patient recovered without further intervention with no major neurologic deficit. Early detection and awareness of this complication may help to avoid unnecessary measures. PMID: 21726109 [PubMed - in process] (Source: Archives of Iranian Medicine)

Unilateral subdural motor cortex stimulation improves essential tremor but not Parkinson's disease

Brain — Thu, 23 Jun 2011 23:00:00 +0100

Epidural motor cortex stimulation has been reported to be effective in treating some movement disorders. Nevertheless, clinical results have been variable and no double-blinded evaluations have been reported. The aim of this study was to investigate efficacy and safety of unilateral subdural motor cortex stimulation in patients with essential tremor and Parkinson’s disease. Six patients with essential tremor and five parkinsonian patients were selected. Craniotomy was performed under local anaesthesia with conscious sedation. A four contact electrode (Resume II model 3587, Medtronic, Inc) was positioned on the motor cortex, after identification of the area with direct monopolar cortical stimulation. Soon after surgery, a variety of different settings of stimulation were assessed usin...

Surgery for gliomas involving the left inferior parietal lobule: new insights into the functional anatomy provided by stimulation mapping in awake patients.

Journal of Neurosurgery — Thu, 23 Jun 2011 23:00:00 +0100

Conclusions To the authors' knowledge, this is the first series dedicated to the surgery of gliomas involving the left IPL. Interestingly, a certain degree of interindividual variability was observed in the distribution of the cortical maps, especially for language. Therefore, it is suggested that no rigid pattern of resection can be considered within the left IPL, and that surgery in this region should be performed in awake patients to adapt the tumor removal to individual functional limits. Nonetheless, several landmarks have been regularly identified, especially at the subcortical levels (SLF III and arcuate fascicle); a better knowledge of these functional tracts could be helpful to optimize functional outcomes. PMID: 21699481 [PubMed - as supplied by publisher] (Source: Journal of...

A prospective controlled study: Minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage

BMC Neurology — Wed, 22 Jun 2011 23:00:00 +0100

ConclusionThese data suggested that the advantage of MISPT was displayed in minute trauma and safety, and seemed to be feasible and to had a trend towards improved long-term outcome.Trial Registration The Australian New Zealand Clinical Trials Registry (ANZCTR)the registration number:ACTRN12610000945022. (Source: BMC Neurology)

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Bypass of the maxillary to proximal middle cerebral artery or proximal posterior cerebral artery with radial artery graft

Acta Neurochirurgica — Fri, 17 Jun 2011 12:00:49 +0100

Abstract The authors report three cases of radial artery (RA) graft bypass from the maxillary artery (MA) to either the middle cerebral artery (MCA) or the posterior cerebral artery (PCA). The first two cases presented with the features of basal ganglion ischemia, and magnetic resonance imaging (MRI) revealed left and right basal ganglion ischemia respectively, whereas angiogram showed MCA occlusion. Computed tomography angiography (CTA) of the third case, who presented with headache and dysphasia, showed a giant basilar artery aneurysm with an absence of the left posterior communicating artery (PComA). The first two cases underwent MA-MCA graft bypass and the third case underwent MA-posterior cerebral artery (PCA) RA graft bypass, followed by clipping of the left dominanc...

Temporizing treatment of hyperacute subdural hemorrhage by subdural evacuation port system placement.

Journal of Neurosurgery — Thu, 16 Jun 2011 23:00:00 +0100

Authors: Flint AC, Gean AD, Manley GT, Rao VA, Sheridan WF, von Koch CS An acute subdural hematoma (SDH) requiring surgical intervention is treated with craniotomy or craniectomy, in part because it is generally accepted that coagulated blood present in the acute phase cannot be adequately evacuated by less-invasive means such as bur hole drainage. However, a hyperacute SDH in the first few hours after trauma can have mixed-density components on CT scans that are thought to represent subdural blood that is not yet fully coagulated. The authors report a case in which a hyperacute SDH in a patient receiving antiplatelet therapy was treated with the novel technique of temporizing subdural evacuation port system (SEPS) placement. Placement of an SEPS in the intensive care unit allowed for ...

Sub‐surface, micrometer‐scale incisions produced in rodent cortex using tightly‐focused femtosecond laser pulses

Lasers in Surgery and Medicine — Thu, 16 Jun 2011 22:19:00 +0100

ConclusionsFemtosecond laser pulses provide the novel capacity for precise, sub‐surface, cellular‐scale cuts for surgical applications in optically scattering tissues. Lasers Surg. Med. 43:382–391, 2011. © 2011 Wiley‐Liss, Inc. (Source: Lasers in Surgery and Medicine)

Surgical treatment of sphenoorbital meningiomas

British Journal of Ophthalmology — Wed, 15 Jun 2011 23:00:00 +0100

Conclusions The surgical aims in the treatment of SOM should be the restoration of visual acuity and reduction of proptosis, rather than complete tumour removal. The surgical approach can be tailored to individual cases. The authors recommend radiotherapy in cases of subtotally removed SOM. (Source: British Journal of Ophthalmology)

Dual-room 1.5-T intraoperative magnetic resonance imaging suite with a movable magnet: implementation and preliminary experience

Urosurgical Review — Wed, 15 Jun 2011 06:18:54 +0100

Abstract We hereby report our initial clinical experience of a dual-room intraoperative magnetic resonance imaging (iMRI) suite with a movable 1.5-T magnet for both neurosurgical and independent diagnostic uses. The findings from the first 45 patients who underwent scheduled neurosurgical procedures with iMRI in this suite (mean age, 41.3 ± 12.0 years; intracranial tumors, 39 patients; cerebral vascular lesions, 5 patients; epilepsy surgery, 1 patient) were reported. The extent of resection depicted at intraoperative imaging, the surgical consequences of iMRI, and the clinical practicability of the suite were analyzed. Fourteen resections with a trans-sphenoidal/transoral approach and 31 craniotomies were performed. Eighty-two iMRI examinations were performed in ...

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The Pott’s puffy tumor: a dangerous sign for intracranial complications

European Archives of Oto-Rhino-Laryngology — Fri, 10 Jun 2011 06:34:33 +0100

Abstract The Pott’s puffy tumor is a subperiosteal abscess of the frontal bone associated with osteomyelitis. The purpose of this article is to alert the physician to the severe complications of this entity. The records of six patients were reviewed retrospectively. There were four adults and two adolescents. Nasal endoscopy showed edematous, polypoid mucosa in middle meatus in three and nasal polyps in the rest. At initial admission, two had orbital subperiosteal abscess, but normal cranial CT findings. During hospitalization, three experienced frontal lobe abscess and one frontal cerebritis. Endoscopic sinus surgery was performed in all with external drainage of Pott’s puffy tumor in addition to antibiotherapy. Three patients underwent craniotomy/craniectomy for remo...

Intraoperative observation of changes in cochlear nerve action potentials during exposure to electromagnetic fields generated by mobile phones

Journal of Neurology, Neurosurgery and Psychiatry — Wed, 08 Jun 2011 23:00:00 +0100

Discussion The possibility that EMF can produce relatively long-lasting effects on cochlear nerve conduction is discussed and analysed in light of contrasting previous literature obtained under non-surgical conditions. Limitations of this novel approach, including the effects of the anaesthetics, craniotomy and surgical procedure, are presented in detail. (Source: Journal of Neurology, Neurosurgery and Psychiatry)

527 Fully Endoscopic Resections of Vestibular Schwannomas

min - Minimally Invasive Neurosurgery — Mon, 06 Jun 2011 23:00:00 +0100

Conclusion: From our experience, we conclude that the endoscope is ideally suited for a minimally invasive approach for resection of vestibular schwannomas.[...]© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: min - Minimally Invasive Neurosurgery)

Microvascular Decompression for Trigeminal Neuralgia due to Compression by the Vertebral Artery: Report of 3 Cases

min - Minimally Invasive Neurosurgery — Mon, 06 Jun 2011 23:00:00 +0100

Conclusion: Among the surgical procedures used in microvascular decompression surgery, dislocation of the offending vessel with Teflon slings is a useful surgical technique to treat trigeminal neuralgia due to a tortuous vertebral artery.[...]© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: min - Minimally Invasive Neurosurgery)