Surgical Neurology最新文献_第4页

Removal of cavernous malformation of the Meckel's cave by extradural pterional approach using Heros muscle dissection technique 应用Heros肌剥离技术经翼点外入路切除Meckel穴海绵状畸形

Surgical Neurology Pub Date : 2009-12-01 Epub Date: 2009-07-15 DOI: 10.1016/j.surneu.2009.04.007

Hakan Seçkin MD, PhD, Nirav Patel MD, Emel Avcı MD, Robert J. Dempsey MD, Mustafa K. Başkaya MD

{"title":"Removal of cavernous malformation of the Meckel's cave by extradural pterional approach using Heros muscle dissection technique","authors":"Hakan Seçkin MD, PhD, Nirav Patel MD, Emel Avcı MD, Robert J. Dempsey MD, Mustafa K. Başkaya MD","doi":"10.1016/j.surneu.2009.04.007","DOIUrl":"10.1016/j.surneu.2009.04.007","url":null,"abstract":"<div><h3>Background</h3><p>We report on a patient with trigeminal neuralgia caused by an extraaxial cavernous malformation (CM) located within Meckel's cave. The lesion was removed via a pterional extradural approach with a modified temporalis muscle dissection technique, which was first described by Heros and Lee. Cadaveric dissections were performed to demonstrate the wider exposure gained by this approach.</p></div><div><h3>Methods</h3><p>A 56-year-old man presented with a history of episodic shocklike, right-sided facial pain for 10 years. Neurologic examination revealed diminished sensation in the mandibular division of the right trigeminal nerve. Magnetic resonance imaging showed an ipsilateral enhancing lesion in Meckel's cave.</p></div><div><h3>Results</h3><p>After placement of a lumbar drain, a right extradural pterional approach was undertaken. By reflecting the temporalis muscle posterolaterally, the craniotomy was extended so that the line of sight was level with the floor of the middle fossa. This allowed access to the lesion without needing to remove the zygoma. The lesion was resected with microsurgical technique. The patient's pain improved significantly after resection, and histopathologic examination confirmed the diagnosis of CM.</p></div><div><h3>Conclusions</h3><p>Extraaxial middle fossa CMs arising solely from Meckel's cave are rare. These lesions are safely and simply approached by posteriorly deflecting the temporalis muscle during a pterional craniotomy, avoiding excessive elevation of the anterior temporal lobe or further bony removal.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 733-736"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.04.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28309977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 9

The combined approach to intracranial aneurysm treatment 联合入路治疗颅内动脉瘤

Surgical Neurology Pub Date : 2009-12-01 Epub Date: 2009-10-09 DOI: 10.1016/j.surneu.2009.06.027

Brian L. Alexander MD , Howard A. Riina MD

{"title":"The combined approach to intracranial aneurysm treatment","authors":"Brian L. Alexander MD , Howard A. Riina MD","doi":"10.1016/j.surneu.2009.06.027","DOIUrl":"10.1016/j.surneu.2009.06.027","url":null,"abstract":"<div><h3>Background</h3><p>A consecutive series of patients with intracranial aneurysms in the practice of one neurovascular surgeon was retrospectively reviewed to illustrate that one physician can become proficient in microneurosurgery as well as endovascular surgery and achieve favorable outcomes in both disciplines. This supports one model of training for cerebrovascular surgeons that includes the complimentary practice of open microneurovascular surgery with endovascular surgery.</p></div><div><h3>Methods</h3><p>The senior author (HAR) treated 351 patients with 413 aneurysms between July 2001 and March 2007. Of these, 172 patients (216 aneurysms) were treated with open microneurosurgical techniques and 179 patients (197 aneurysms) were treated using endovascular techniques.</p></div><div><h3>Results</h3><p>Complete obliteration was attained in 94.3% of clipped aneurysms, and 61.9% and 65.9% of coiled aneurysms immediately and after at least 6 months of follow-up, respectively. At latest evaluation, 93% of endovascular patients and 90% of microneurosurgical patients had good clinical outcomes (GOS, 4 or 5; mean follow-up, 23 months; combines ruptured and unruptured cohorts). Procedure-related mortality included 1 surgical patient and 2 endovascular patients.</p></div><div><h3>Conclusions</h3><p>Because the fields of microvascular and endovascular surgeries are both technically complex, there has been concern that hybrid cerebrovascular surgeons cannot perform each technique with the skill necessary to achieve good outcomes. When compared to clipping and coiling reviews in the neurosurgical literature, we illustrate that one hybrid neurovascular surgeon is capable of attaining great facility in both techniques and that this type of physician will represent one practice model of cerebrovascular specialist in the future. This has potential implications for the training of hybrid cerebrovascular surgeons.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 596-606"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.06.027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28429439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 12

Commentary 评论

Surgical Neurology Pub Date : 2009-12-01 Epub Date: 2009-11-26 DOI: 10.1016/j.wneu.2009.09.006

Konstantin Slavin MD

引用次数: 0

Commentary 评论

Surgical Neurology Pub Date : 2009-12-01 Epub Date: 2009-08-07 DOI: 10.1016/j.surneu.2009.05.032

Liang Chen MD, Liang-Fu Zhou MD

引用次数: 0

A note of gratitude to the readers of Surgical Neurology 感谢《外科神经病学》的读者

Surgical Neurology Pub Date : 2009-12-01 Epub Date: 2009-12-16 DOI: 10.1016/j.wneu.2009.09.013

James I. Ausman MD, PhD (Editor)

引用次数: 0

Technology or judgment? 技术还是判断?

Surgical Neurology Pub Date : 2009-12-01 Epub Date: 2009-12-16 DOI: 10.1016/j.wneu.2009.09.015

James I. Ausman MD, PhD (Editor)

引用次数: 0

Comparison of postoperative cognitive function in patients undergoing surgery for ruptured and unruptured intracranial aneurysm 颅内动脉瘤破裂与未破裂患者术后认知功能的比较

Surgical Neurology Pub Date : 2009-12-01 Epub Date: 2009-12-16 DOI: 10.1016/j.surneu.2009.06.016

Yasunari Otawara MD , Kuniaki Ogasawara MD , Yoshitaka Kubo MD , Hiroshi Kashimura MD , Akira Ogawa MD , Keiko Yamadate BSc

{"title":"Comparison of postoperative cognitive function in patients undergoing surgery for ruptured and unruptured intracranial aneurysm","authors":"Yasunari Otawara MD , Kuniaki Ogasawara MD , Yoshitaka Kubo MD , Hiroshi Kashimura MD , Akira Ogawa MD , Keiko Yamadate BSc","doi":"10.1016/j.surneu.2009.06.016","DOIUrl":"10.1016/j.surneu.2009.06.016","url":null,"abstract":"<div><h3>Background</h3><p>Patients with SAH often experience cognitive decline. Previous studies used normal volunteers, published normal test values, and orthopedic patients as controls to identify factors for postoperative cognitive decline. The present study excluded the effects of surgery by comparing cognitive function after surgical repair in patients with aneurysmal SAH and patients with unruptured intracranial aneurysm.</p></div><div><h3>Methods</h3><p>This study recruited 117 patients with SAH due to ruptured aneurysm and 39 patients with incidentally found unruptured intracranial aneurysms. The cognitive test battery consisted of the Japanese translation of the WAIS-R, the Japanese translation of the WMS, and the recall trial of the ROCF. Postoperative neuropsychological test scores for the patients with SAH and control subjects were compared using group-rate and event-rate analysis. The relationship between clinical variable and postoperative cognitive decline in the patients with SAH was evaluated by univariate analysis using the Mann-Whitney <em>U</em> test or <em>χ</em><sup>2</sup> test.</p></div><div><h3>Results</h3><p>Group-rate analysis showed that the WAIS-R and ROCF scores were significantly lower in the SAH group than in the control group. Event-rate analysis demonstrated that the incidence of cognitive decline in the patients with SAH (73 [62.4%] of the 117 patients) was significantly higher than that in the control subjects (12 [30.8%] of 39 patients). The Hunt and Hess grade was significantly higher in patients with postoperative cognitive decline.</p></div><div><h3>Conclusion</h3><p>The cognitive function after SAH was significantly correlated with Hunt and Hess grade on admission when using patients with postoperative unruptured intracranial aneurysm as the control group.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 592-595"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.06.016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28654347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 21

Implant design may influence delayed heterotopic ossification after total disk arthroplasty in lumbar spine 植入物设计可能影响腰椎全椎间盘置换术后延迟异位骨化

Surgical Neurology Pub Date : 2009-12-01 Epub Date: 2009-12-16 DOI: 10.1016/j.surneu.2009.04.009

Eubulus J. Kerr MD, Ajay Jawahar MD, MS, Stephen Kay PA-C, David A. Cavanaugh MD, Pierce D. Nunley MD

{"title":"Implant design may influence delayed heterotopic ossification after total disk arthroplasty in lumbar spine","authors":"Eubulus J. Kerr MD, Ajay Jawahar MD, MS, Stephen Kay PA-C, David A. Cavanaugh MD, Pierce D. Nunley MD","doi":"10.1016/j.surneu.2009.04.009","DOIUrl":"10.1016/j.surneu.2009.04.009","url":null,"abstract":"<div><h3>Background</h3><p>As total disk arthroplasty (TDA) gains increasing acceptance as an alternative to fusion for degenerative disk disease of the lumbar spine, new complications are encountered by the physicians during and after the procedure. We hereby report a complication after TDA in the lumbar spine that is in variance from previously proposed theories and suggests the possibility of implant design as one of the etiologic factors. The purpose of the present submission is to report a case of delayed heterotopic ossification (HO) after TDA that suggests that the keel-based design of the implant might have contributed to the etiology.</p></div><div><h3>Case description</h3><p>The patient underwent TDA for L3-4 degenerative disk disease and had fusion surgery for L5-S1 disease about 6 months later. During follow-up, development of significant HO was noticed at the L3 and L4 level. Radiologic studies revealed the origin of HO to be the keel cut made in the body of L3 to accommodate the keel-based artificial disk.</p></div><div><h3>Conclusion</h3><p>The exact etiology of HO after TDA is not clear. The presented anecdote points toward vertebral body trauma due to the design of the implant as a possible factor that needs to be studied more elaborately.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 747-751"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.04.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28654354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

Emergency endovascular Stent graft and coil placement for internal carotid artery injury during transsphenoidal surgery 经蝶窦手术中内颈动脉损伤的急诊血管内支架置入和血管圈置入

Surgical Neurology Pub Date : 2009-12-01 Epub Date: 2009-07-14 DOI: 10.1016/j.surneu.2009.05.003

Young Seok Park MD , Jin Young Jung MD , Jung Yong Ahn MD, PhD , Dong Jun Kim MD, PhD , Sun Ho Kim MD, PhD

{"title":"Emergency endovascular Stent graft and coil placement for internal carotid artery injury during transsphenoidal surgery","authors":"Young Seok Park MD , Jin Young Jung MD , Jung Yong Ahn MD, PhD , Dong Jun Kim MD, PhD , Sun Ho Kim MD, PhD","doi":"10.1016/j.surneu.2009.05.003","DOIUrl":"10.1016/j.surneu.2009.05.003","url":null,"abstract":"<div><h3>Background</h3><p>An internal carotid artery (ICA) injury is an uncommon but potentially fatal complication of transsphenoidal surgery.</p></div><div><h3>Case Description</h3><p>We report a 61-year-old male patient with a right cavernous ICA injury sustained during transsphenoidal surgery and who underwent endovascular Stent graft placement. The ICA trapping was not indicated because of the absence of the left A1 on preoperative magnetic resonance angiography. During Stent graft placement, the ICA wall could not be completely fit with a stent due to its stiff nature and the carotid curve. The gap between the stent and the ICA wall was filled using a coiling procedure on the first postoperative day.</p></div><div><h3>Conclusions</h3><p>Endovascular Stent graft placement for posttranssphenoidal carotid artery injury is a useful technical adjunct to the management strategy and has the potential to minimize the risk of having to sacrifice the ICA. In cases of incomplete reconstruction of the Stent graft placement due to its stiff nature and the carotid curve, an additional coiling procedure could be helpful to obliterate the gap between the stent and the ICA wall. To avoid carotid injury during transsphenoidal surgery, careful preoperative evaluation of vascular structures and meticulous surgical technique are necessary.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 741-746"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.05.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28309244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 32

Hyaluronic acid inhibits the glial scar formation after brain damage with tissue loss in rats 透明质酸抑制大鼠脑组织损伤后神经胶质瘢痕形成

Surgical Neurology Pub Date : 2009-12-01 Epub Date: 2009-11-26 DOI: 10.1016/j.wneu.2009.09.004

Chien-Min Lin MD , Jia-Wei Lin MD, PhD , Yen-Chou Chen PhD , Hsin-Hsin Shen PhD , Li Wei MD , Yi-Shian Yeh MD , Yung-Hsiao Chiang MD, PhD , Raymond Shih BS , Pei-Ling Chiu BS , Kuo-Sheng Hung MD, PhD , Liang-Yo Yang DVM, PhD , Wen-Ta Chiu MD, PhD

{"title":"Hyaluronic acid inhibits the glial scar formation after brain damage with tissue loss in rats","authors":"Chien-Min Lin MD , Jia-Wei Lin MD, PhD , Yen-Chou Chen PhD , Hsin-Hsin Shen PhD , Li Wei MD , Yi-Shian Yeh MD , Yung-Hsiao Chiang MD, PhD , Raymond Shih BS , Pei-Ling Chiu BS , Kuo-Sheng Hung MD, PhD , Liang-Yo Yang DVM, PhD , Wen-Ta Chiu MD, PhD","doi":"10.1016/j.wneu.2009.09.004","DOIUrl":"10.1016/j.wneu.2009.09.004","url":null,"abstract":"<div><h3>Background</h3><p>Brain tissue scarring (gliosis) was believed to be the major cause of epileptic focus after brain injury, and prevention of scarring could reduce the incidence of seizure. We tried the HA coating onto the cortical brain defect of Spraque-Dawley rats to reduce the marginal glial scarring.</p></div><div><h3>Methods</h3><p>A 4 × 2 × 2 mm<sup>3</sup> cortical defect was created in the brain of Spraque-Dawley rats. Three percent HA gel was coated onto the lesion for the experimental groups and normal saline solutions for the control groups. The brain was retrieved 4, 8, and 12 weeks after treatment. The brains were then sectioned and processed for H&E and GFAP staining, and the thickness of the scarring and the number of GFAP+ cells were analyzed.</p></div><div><h3>Results</h3><p>The thickness of cutting marginal gliosis was significantly decreased in the HA groups. The 12-week HA group showed the smallest thickness of gliosis, whereas the 12-week control group exhibited the largest thickness of gliosis. The significant difference in the thickness of gliosis was also noted between the HA and the control groups 8 weeks after treatment. The number of GFAP+ cells was also significantly decreased in the HA groups when compared to the respective control group 4, 8, and 12 weeks after the surgery.</p></div><div><h3>Conclusion</h3><p>The results support the hypothesis that HA inhibits glial scarring not only by decreasing the thickness of gliosis but also by reducing the number of the glial cells. Furthermore, our results suggest that HA might be used to reduce glial scar formation in central nervous system surgery, which subsequently prevents the post-operation or posttraumatic seizure incidence.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 ","pages":"Pages S50-S54"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.wneu.2009.09.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28534049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 63