Radiosurgery has been used to treat a variety of intracranial disorders, including arteriovenous malformations, metastatic brain tumors, vestibular schwannomas, and meningiomas. Radiosurgery is an outpatient treatment, with minimal treatment-associated morbidity, and, as such, provides an attractive alternative to open surgery for carefully selected cases. A large number of gamma knife– and linear accelerator–based clinical series have now been published, documenting high long-term (5-to 10-year) meningioma control rates and low morbidity. Certain meningioma locations are known to be associated with higher risk for surgical morbidity, including cavernous sinus, tentorium, posterior fossa, and posterior sagittal sinus. In addition, meningioma surgery appears to involve higher morbidity in the elderly. Many neurosurgeons now consider radiosurgery to be the treat-ment of choice for small meningiomas in high-risk locations or in the elderly.
{"title":"Linear Accelerator Radiosurgery for Meningiomas","authors":"W. Friedman","doi":"10.1055/s-2004-828930","DOIUrl":"https://doi.org/10.1055/s-2004-828930","url":null,"abstract":"Radiosurgery has been used to treat a variety of intracranial disorders, including arteriovenous malformations, metastatic brain tumors, vestibular schwannomas, and meningiomas. Radiosurgery is an outpatient treatment, with minimal treatment-associated morbidity, and, as such, provides an attractive alternative to open surgery for carefully selected cases. A large number of gamma knife– and linear accelerator–based clinical series have now been published, documenting high long-term (5-to 10-year) meningioma control rates and low morbidity. Certain meningioma locations are known to be associated with higher risk for surgical morbidity, including cavernous sinus, tentorium, posterior fossa, and posterior sagittal sinus. In addition, meningioma surgery appears to involve higher morbidity in the elderly. Many neurosurgeons now consider radiosurgery to be the treat-ment of choice for small meningiomas in high-risk locations or in the elderly.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132314455","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}
John Jane Jr.1, Aaron Dumont1, Mary Vance2, Edward Laws Jr.1
The transsphenoidal approach is the preferred method for removal of pituitary tumors. Suprasellar tumors may also be approached transsphenoidally in the setting of an expanded sella turcica. Suprasellar tumors that are fibrous and not associated with an expanded sella are generally treated with craniotomy. However, transcranial resection of suprasellar meningiomas carries significant risk to the optic apparatus. The transsphe-noidal approach may be modified to provide access for resection of suprasellar meningiomas. A consecutive series of patients with suprasellar meningiomas who underwent a transsphenoidal transtuberculum sellae approach were reviewed retrospectively. From January 2000 to July 2002, six patients underwent the transsphenoidal transtuberculum sellae approach. All patients underwent thorough preoperative and postoperative ophthalmologic and endocrinologic testing. Magnetic resonance imaging of all patients was obtained preoperatively, 6 weeks to 3 months postoperatively, and annually. Two patients presented with visual dysfunction and one had signs of endocrine dysfunction. Tumor diameter ranged from 1.5 to 2.5 cm with a mean diameter of 2.1 cm and all tumors revealed magnetic resonance evidence of chiasmatic compression. Gross total resection was accomplished in four of six (67%) patients and no patient has experienced recurrence. Vision improved in both patients who presented with visual dysfunction and one patient with normal vision preoperatively experienced a mild bitemporal hemianopsia. Vision remained normal or improved in 83%. No patient required pituitary hormone replacement postoperatively and no patient experienced cerebrospinal fluid rhinorrhea.The transsphe-noidal transtuberculum sellae approach represents a viable alternative to craniotomy for selected suprasellar meningiomas.
{"title":"The Transsphenoidal Transtuberculum Sellae Approach for Suprasellar Meningiomas","authors":"John Jane Jr.1, Aaron Dumont1, Mary Vance2, Edward Laws Jr.1","doi":"10.1055/s-2004-828924","DOIUrl":"https://doi.org/10.1055/s-2004-828924","url":null,"abstract":"The transsphenoidal approach is the preferred method for removal of pituitary tumors. Suprasellar tumors may also be approached transsphenoidally in the setting of an expanded sella turcica. Suprasellar tumors that are fibrous and not associated with an expanded sella are generally treated with craniotomy. However, transcranial resection of suprasellar meningiomas carries significant risk to the optic apparatus. The transsphe-noidal approach may be modified to provide access for resection of suprasellar meningiomas. A consecutive series of patients with suprasellar meningiomas who underwent a transsphenoidal transtuberculum sellae approach were reviewed retrospectively. From January 2000 to July 2002, six patients underwent the transsphenoidal transtuberculum sellae approach. All patients underwent thorough preoperative and postoperative ophthalmologic and endocrinologic testing. Magnetic resonance imaging of all patients was obtained preoperatively, 6 weeks to 3 months postoperatively, and annually. Two patients presented with visual dysfunction and one had signs of endocrine dysfunction. Tumor diameter ranged from 1.5 to 2.5 cm with a mean diameter of 2.1 cm and all tumors revealed magnetic resonance evidence of chiasmatic compression. Gross total resection was accomplished in four of six (67%) patients and no patient has experienced recurrence. Vision improved in both patients who presented with visual dysfunction and one patient with normal vision preoperatively experienced a mild bitemporal hemianopsia. Vision remained normal or improved in 83%. No patient required pituitary hormone replacement postoperatively and no patient experienced cerebrospinal fluid rhinorrhea.The transsphe-noidal transtuberculum sellae approach represents a viable alternative to craniotomy for selected suprasellar meningiomas.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121869150","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}
Stroke remains a major medical problem because of its high rate of morbidity and mortality. 1 Atherosclerotic disease of the carotid artery continues to be a contributing factor in many strokes. The effectiveness of carotid endarterectomy (CEA) for patients with carotid occlusive disease, with or without neurological symptoms, has been substantiated by several studies. 2–9 Although patients likely to experience the benefit of decreased stroke risk from CEA have been identified, there are a variety of specific technical details in performing the surgery that may help to decrease the stroke risk of the procedure itself. Meticulous attention to the fundamental techniques in the performance of a CEA is the primary means of reducing operative risk and is discussed here. In addition, the role of several divergent techniques proposed to further reduce operative risk, such as the type of anesthesia, the type of incision, the use of intraoperative shunting, the method of vessel closure, the use of the operating microscope, and the use of eversion versus conventional endarterectomy technique is reviewed.
{"title":"A Review of Techniques Used for the Successful Performance of Carotid Endarterectomy","authors":"P. Cooper, J. McInerney","doi":"10.1055/s-2002-39939","DOIUrl":"https://doi.org/10.1055/s-2002-39939","url":null,"abstract":"Stroke remains a major medical problem because of its high rate of morbidity and mortality. 1 Atherosclerotic disease of the carotid artery continues to be a contributing factor in many strokes. The effectiveness of carotid endarterectomy (CEA) for patients with carotid occlusive disease, with or without neurological symptoms, has been substantiated by several studies. 2–9 Although patients likely to experience the benefit of decreased stroke risk from CEA have been identified, there are a variety of specific technical details in performing the surgery that may help to decrease the stroke risk of the procedure itself. Meticulous attention to the fundamental techniques in the performance of a CEA is the primary means of reducing operative risk and is discussed here. In addition, the role of several divergent techniques proposed to further reduce operative risk, such as the type of anesthesia, the type of incision, the use of intraoperative shunting, the method of vessel closure, the use of the operating microscope, and the use of eversion versus conventional endarterectomy technique is reviewed.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126152626","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}
C arpal tunnel syndrome is the most common nerve entrapment syndrome treated in the United States, affecting approximately 1% of the population. 1–3 Initial treatment for carpal tunnel syndrome is usually nonoperative and includes the use of splints, non-steroidal anti-inflammatory agents, and steroid injections. If these methods fail, then operative intervention is frequently indicated. Open carpal tunnel release (CTR) has been the gold standard for operative treat-ment of carpal tunnel syndrome. 4 With the recent advent of endoscopic CTR, the gold standard has been challenged. Endoscopic CTR offers the advantages of a quicker return to work and less scar tenderness to the patient. However, open CTR affords the patient a lower complication rate and better visualization of the nerve and the contents of the carpal canal. 5,6 No matter which technique is chosen the vast majority of patients obtain relief of their symptoms following CTR. Reviews of large series of patients reveal an incidence of failure or incomplete relief of symptoms that ranges from 1.6 to 25%. 4,7–9 The evaluation and treatment of this subset of patients can be difficult. The incidence of reoperation for failed carpal tunnel syndrome has been estimated as approximately 0.5%. 10 This article will help the clinician sort through the history, physical exam, and supportive studies of
{"title":"Evaluation and Treatment of Failed Carpal Tunnel Surgery","authors":"G. Farber, C. Litts, M.D.","doi":"10.1055/s-2001-13003","DOIUrl":"https://doi.org/10.1055/s-2001-13003","url":null,"abstract":"C arpal tunnel syndrome is the most common nerve entrapment syndrome treated in the United States, affecting approximately 1% of the population. 1–3 Initial treatment for carpal tunnel syndrome is usually nonoperative and includes the use of splints, non-steroidal anti-inflammatory agents, and steroid injections. If these methods fail, then operative intervention is frequently indicated. Open carpal tunnel release (CTR) has been the gold standard for operative treat-ment of carpal tunnel syndrome. 4 With the recent advent of endoscopic CTR, the gold standard has been challenged. Endoscopic CTR offers the advantages of a quicker return to work and less scar tenderness to the patient. However, open CTR affords the patient a lower complication rate and better visualization of the nerve and the contents of the carpal canal. 5,6 No matter which technique is chosen the vast majority of patients obtain relief of their symptoms following CTR. Reviews of large series of patients reveal an incidence of failure or incomplete relief of symptoms that ranges from 1.6 to 25%. 4,7–9 The evaluation and treatment of this subset of patients can be difficult. The incidence of reoperation for failed carpal tunnel syndrome has been estimated as approximately 0.5%. 10 This article will help the clinician sort through the history, physical exam, and supportive studies of","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124104832","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}
{"title":"Pediatric Neurosurgery for the General Neurosurgeon","authors":"R. Ellenbogen","doi":"10.1055/S-2002-35242","DOIUrl":"https://doi.org/10.1055/S-2002-35242","url":null,"abstract":"","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129296108","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}
Apoptosis, a form of programmed cell suicide, can be thought of as one mechanism by which organisms prevent the formation and progression of malignant neoplasms. Cells that have incurred irreparable damage to their DNA and subsequently escaped the tight controls placed upon proliferation and migration may be eliminated, under normal circumstances, by activation of their intrinsic apoptotic program. Deac-tivation of the apoptotic program, and hence propagation of mutations produced by DNA damage, may be a necessary precursor to cancer. This article describes the basic cellular elements and signal transduction pathways that underlie apoptosis and examines in more detail the potential role(s) that each of these elements may play in the genesis and progression of glial neoplasms. Finally, it describes attempts that have been made to design clinical therapies directed at increasing the sensitivity of these tumors to apoptotic stimuli
{"title":"Apoptosis in Glial Brain Tumors","authors":"M. Vogelbaum","doi":"10.1055/s-2000-9363","DOIUrl":"https://doi.org/10.1055/s-2000-9363","url":null,"abstract":"Apoptosis, a form of programmed cell suicide, can be thought of as one mechanism by which organisms prevent the formation and progression of malignant neoplasms. Cells that have incurred irreparable damage to their DNA and subsequently escaped the tight controls placed upon proliferation and migration may be eliminated, under normal circumstances, by activation of their intrinsic apoptotic program. Deac-tivation of the apoptotic program, and hence propagation of mutations produced by DNA damage, may be a necessary precursor to cancer. This article describes the basic cellular elements and signal transduction pathways that underlie apoptosis and examines in more detail the potential role(s) that each of these elements may play in the genesis and progression of glial neoplasms. Finally, it describes attempts that have been made to design clinical therapies directed at increasing the sensitivity of these tumors to apoptotic stimuli","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123101780","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}
Sabine Hancq1, Danielle Baleriaux2, Jacques Brotchi1
Surgery of parasagittal meningiomas may represent a real challenge when the superior sagittal sinus (SSS) is involved. The surgeon is often faced with bridging veins, which must be preserved to prevent massive postoperative neurological deficit. Today, magnetic resonance imaging (MRI) is the examination of choice. Magnetic resonance angiography (MRA) allows a precise study of the venous circulation. Indeed, surgery of parasagittal meningioma consists mainly of surgery and dissection of all the veins that surround the tumor, including bridging and parasagittal veins, SSS, and collateral channels. MRA shows whether or not the SSS is patent, demonstrates the direction of venous flow, and helps in planning surgical technique.The goal is complete removal of the tumor, but quality of life issues must be considered. In the past 10 years, a less aggressive attitude toward SSS reconstruction has evolved. When more than one wall is invaded, we favor resection of the tumor outside the SSS and yearly MRI follow-up. When residual tumor grows, we treat with radiosurgery. When the SSS is occluded, we may remove it without grafting, preserving all the collateral venous channels, which have been carefully analyzed by MRA.
{"title":"Surgical Treatment of Parasagittal Meningiomas","authors":"Sabine Hancq1, Danielle Baleriaux2, Jacques Brotchi1","doi":"10.1055/s-2004-828923","DOIUrl":"https://doi.org/10.1055/s-2004-828923","url":null,"abstract":"Surgery of parasagittal meningiomas may represent a real challenge when the superior sagittal sinus (SSS) is involved. The surgeon is often faced with bridging veins, which must be preserved to prevent massive postoperative neurological deficit. Today, magnetic resonance imaging (MRI) is the examination of choice. Magnetic resonance angiography (MRA) allows a precise study of the venous circulation. Indeed, surgery of parasagittal meningioma consists mainly of surgery and dissection of all the veins that surround the tumor, including bridging and parasagittal veins, SSS, and collateral channels. MRA shows whether or not the SSS is patent, demonstrates the direction of venous flow, and helps in planning surgical technique.The goal is complete removal of the tumor, but quality of life issues must be considered. In the past 10 years, a less aggressive attitude toward SSS reconstruction has evolved. When more than one wall is invaded, we favor resection of the tumor outside the SSS and yearly MRI follow-up. When residual tumor grows, we treat with radiosurgery. When the SSS is occluded, we may remove it without grafting, preserving all the collateral venous channels, which have been carefully analyzed by MRA.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125607139","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}
intracranial tumors, they have been referred to as “the soul of neurosurgery.” This is because meningiomas, in their diagnosis, imaging, and treatment, parallel the evolution of neurosurgery.Treatment of these usually benign tumors can be one of the most satisfying aspects of neurosurgical practice. Microsurgical removal is enhanced by advanced technology, including microscopes, lasers, endoscopes, and frameless image guidance. The meticulous neurosurgeon is rewarded with long-term patient survivals and even cures. Adjunctive treatment of meningiomas with radiosurgery can allow long-term tumor control in patients whose lesion cannot be surgically resected. On the other hand, the small minority of meningiomas that are malignant continue to defy attempts to eradicate them. This issue of Seminars in Neurosurgery provides an up-to-date and comprehensive summary of our understanding of this fascinating tumor at the current time. The contributors to this issue compose an international list of experts in the field. I thank them for their superb contributions, which are both thorough and completely up-to-date. This issue begins with a thoughtful review of the history of meningiomas presented by Drs. Wang, Lanzino, and Laws. Drs. Ragel and Jensen, as well as Drs. Ware, Quinones-Hinojosa, and McDermott, have provided excellent offerings on pathophysiology that will help neurosurgeons answer with some degree of scientific precision the commonly asked patient question: “How did I get this tumor?” Dr. Raksin’s article completes the pre-operative discussion by detailing appropriate imaging of such lesions. The next section describes surgical management of these tumors. Region by region, details of technique are discussed by experts in the field. Drs. Hancq, Baleriaux, and Brotchi present the evolution of their experience with parasagittal meningiomas. Drs. Jane, Dumont, Vance, and Laws describe the evolution of their transsphenoidal transtuberculum approach for suprasellar meningiomas. Drs. Vecil and McCutcheon, Margalit and Sen, and D’Ambrosio et al carefully detail their surgical technique for meningioma resection in the convexity, foramen magnum, and lateral ventricles, respectively. Dr. White describes surgical management of spinal meningiomas. Drs. Mizen and Rosseau present meningiomas of the orbit, optic nerves, and anterior visual pathways. The next section deals with radiosurgery for treatment of meningiomas. Dr. Friedman presents his experience with the linear accelerator for such tumors, and Dr. Duma et al describe the use of the gamma knife. Finally, Drs. Rosseau and Cokluk describe the unfortunate tendency of meningiomas to recur, and outline treatment strategies when this happens. Drs. Hentschel and McCutcheon further describe chemotherapy and biological therapy as adjunctive treatment for meningiomas. It is our hope that this issue of Seminars in Neurosurgery will provide the neurosurgeon with a comprehensive and completely up-to-date summary of
{"title":"Meningiomas: Contemporary Treatment","authors":"Winfield S Fisher Iii","doi":"10.1055/s-2004-817733","DOIUrl":"https://doi.org/10.1055/s-2004-817733","url":null,"abstract":"intracranial tumors, they have been referred to as “the soul of neurosurgery.” This is because meningiomas, in their diagnosis, imaging, and treatment, parallel the evolution of neurosurgery.Treatment of these usually benign tumors can be one of the most satisfying aspects of neurosurgical practice. Microsurgical removal is enhanced by advanced technology, including microscopes, lasers, endoscopes, and frameless image guidance. The meticulous neurosurgeon is rewarded with long-term patient survivals and even cures. Adjunctive treatment of meningiomas with radiosurgery can allow long-term tumor control in patients whose lesion cannot be surgically resected. On the other hand, the small minority of meningiomas that are malignant continue to defy attempts to eradicate them. This issue of Seminars in Neurosurgery provides an up-to-date and comprehensive summary of our understanding of this fascinating tumor at the current time. The contributors to this issue compose an international list of experts in the field. I thank them for their superb contributions, which are both thorough and completely up-to-date. This issue begins with a thoughtful review of the history of meningiomas presented by Drs. Wang, Lanzino, and Laws. Drs. Ragel and Jensen, as well as Drs. Ware, Quinones-Hinojosa, and McDermott, have provided excellent offerings on pathophysiology that will help neurosurgeons answer with some degree of scientific precision the commonly asked patient question: “How did I get this tumor?” Dr. Raksin’s article completes the pre-operative discussion by detailing appropriate imaging of such lesions. The next section describes surgical management of these tumors. Region by region, details of technique are discussed by experts in the field. Drs. Hancq, Baleriaux, and Brotchi present the evolution of their experience with parasagittal meningiomas. Drs. Jane, Dumont, Vance, and Laws describe the evolution of their transsphenoidal transtuberculum approach for suprasellar meningiomas. Drs. Vecil and McCutcheon, Margalit and Sen, and D’Ambrosio et al carefully detail their surgical technique for meningioma resection in the convexity, foramen magnum, and lateral ventricles, respectively. Dr. White describes surgical management of spinal meningiomas. Drs. Mizen and Rosseau present meningiomas of the orbit, optic nerves, and anterior visual pathways. The next section deals with radiosurgery for treatment of meningiomas. Dr. Friedman presents his experience with the linear accelerator for such tumors, and Dr. Duma et al describe the use of the gamma knife. Finally, Drs. Rosseau and Cokluk describe the unfortunate tendency of meningiomas to recur, and outline treatment strategies when this happens. Drs. Hentschel and McCutcheon further describe chemotherapy and biological therapy as adjunctive treatment for meningiomas. It is our hope that this issue of Seminars in Neurosurgery will provide the neurosurgeon with a comprehensive and completely up-to-date summary of ","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125696176","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}
Anterior cervical discectomy and fusion (ACDF) procedures have been performed for over 50 years. While complications are minimal and results are generally good, the most common complication is nonunion. Various approaches to repair these nonunions have been suggested. Anterior revision surgery results in a fusion in up to 97% of patients with minimal to no complications. Posterior revision surgery produces up to 100% fusion rates with a similar minimal complication occurrence. Some support exists for combined anterior/posterior approach with 100% fusion rate and no complications. No large multicenter randomized prospective study provides definitive evidence to support one approach over another
{"title":"Treatment Options for Failure of Anterior Cervical Discectomy and Fusion","authors":"T. Puckett","doi":"10.1055/s-2003-41151","DOIUrl":"https://doi.org/10.1055/s-2003-41151","url":null,"abstract":"Anterior cervical discectomy and fusion (ACDF) procedures have been performed for over 50 years. While complications are minimal and results are generally good, the most common complication is nonunion. Various approaches to repair these nonunions have been suggested. Anterior revision surgery results in a fusion in up to 97% of patients with minimal to no complications. Posterior revision surgery produces up to 100% fusion rates with a similar minimal complication occurrence. Some support exists for combined anterior/posterior approach with 100% fusion rate and no complications. No large multicenter randomized prospective study provides definitive evidence to support one approach over another","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126348750","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}
Traumatic injuries of the brachial plexus may result in severe and permanent loss of motor and sensory function of the involved extremity. The neurosurgeon’s ability to improve the functional outcome following a plexus injury requires an understanding of the functional anatomy of the brachial plexus, the pathophysiology of nerve injury, and the natural history of these lesions. Primary reanastomosis, neurolysis, and nerve grafting techniques are commonly used to restore normal axonal continuity. When these options are unavailable, muscle and tendon transfers or neurotization techniques have been successful in achieving functional restoration of limb movements.
{"title":"Evaluation and Surgical Repair of Brachial Plexus Injuries","authors":"E. Gabriel, A. Villavicencio, A. Friedman","doi":"10.1055/s-2001-12997","DOIUrl":"https://doi.org/10.1055/s-2001-12997","url":null,"abstract":"Traumatic injuries of the brachial plexus may result in severe and permanent loss of motor and sensory function of the involved extremity. The neurosurgeon’s ability to improve the functional outcome following a plexus injury requires an understanding of the functional anatomy of the brachial plexus, the pathophysiology of nerve injury, and the natural history of these lesions. Primary reanastomosis, neurolysis, and nerve grafting techniques are commonly used to restore normal axonal continuity. When these options are unavailable, muscle and tendon transfers or neurotization techniques have been successful in achieving functional restoration of limb movements.","PeriodicalId":287382,"journal":{"name":"Seminars in Neurosurgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116052732","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}
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