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Operations Using a Frameless Stereotactic System with a Marker: Technical Note 使用带标记的无框立体定向系统的操作:技术说明
Pub Date : 2001-09-01 DOI: 10.1055/S-2001-18125
T. Kuroiwa, T. Ohta
One of the most critical problems in navigation systems is that of brain shifts during operations. In order to solve this problem, we developed a simple method using a marker placed prior to microsurgery to provide a reference point. We produced a thin probe. After the dural incision, the probe, covered with a silicone tube, was inserted into the target point. Then only the probe was removed, leaving the silicone tube in place. This tube moved together with the brain, which deviated during the operation, and throughout the operation indicated the same point as that which it was pointed at first. This result suggests that this is a simple and useful method to allow navigation systems to accommodate brain shifts during operations.
导航系统中最关键的问题之一是操作过程中大脑的变化。为了解决这个问题,我们开发了一种简单的方法,使用显微手术前放置的标记来提供参考点。我们制作了一个薄探针。在硬脑膜切开后,用硅胶管覆盖探针插入目标点。然后只取出探针,留下硅胶管。这根管子和大脑一起移动,大脑在手术过程中发生了偏移,在整个手术过程中,它指向的点和最初指向的点是一样的。这一结果表明,这是一种简单而有用的方法,可以让导航系统适应手术过程中大脑的变化。
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引用次数: 3
Interactive Image-Guided Transcallosal Microsurgery for Anterior Third Ventricular Cysts 交互式影像引导下经胼胝体显微手术治疗前第三脑室囊肿
Pub Date : 2001-09-01 DOI: 10.1055/s-2001-18123
T. S. Paleologos, J. Wadley, N. Kitchen, D. Thomas
Although the treatment of colloid cysts remains controversial, high viscosity and small volume are poor prognostic indicators for successful burr hole aspiration and cortical incision via craniotomy may be associated with postoperative epilepsy. The anterior transcallosal approach provides a direct and adequate pathway to the lateral ventricles, where the foramen of Monro serves as a natural entrance into the anterior third ventricle, especially when the foramen is dilated by a lesion. When the midsuperior portion of the IIIrd ventricle cannot be reached, the interforniceal or the subchoroidal exposures have been advocated. Stereotactic techniques contribute to a minimal invasive approach and reduce morbidity. Nine patients harbouring anterior third ventricular cysts (seven colloids and two intrinsic craniopharyngiomas) underwent anterior transcallosal microsurgical excision assisted by an interactive infrared-based image guided system (EasyGuide, Neuro, Philips). There were 4 men and 5 women ranging in age from 15 to 42 years (mean 28.5). Transcallosal transforaminal (5 cases) or interforniceal (4 cases) approaches allowed total excision in eight patients and subtotal in one. Postoperative morbidity included a case of transient hemiparesis and a case of transient short-term memory disturbances; both resolved in the first months. Mortality was zero. Particular advantages of the method were accurate trajectory and position of callosotomy incision determination, visualisation and avoidance of superior saggital sinus, retraction of bridging veins and the often variable pericallosal arteries, spatial orientation within the ventricular system, and identification of the periventricular anatomical structures.
尽管胶体囊肿的治疗方法仍有争议,但高粘度和小体积是成功的钻孔抽吸和颅骨皮质切口的不良预后指标,可能与术后癫痫有关。前经胼胝体入路为侧脑室提供了直接和充分的通路,其中Monro孔作为进入前第三脑室的自然入口,特别是当孔因病变而扩张时。当不能到达第三脑室的中上部时,建议采用筋膜间或脉络膜下显露。立体定向技术有助于微创入路并降低发病率。9例前第三脑室囊肿(7例胶质瘤和2例内生性颅咽管瘤)患者在交互式红外图像引导系统(EasyGuide, Neuro, Philips)的辅助下接受了前路经胼胝体显微手术切除。男4例,女5例,年龄15 ~ 42岁,平均28.5岁。经胼胝体经椎间孔入路(5例)或孔间入路(4例)允许8例患者全切,1例患者次全切。术后发病包括1例短暂性偏瘫和1例短暂性短期记忆障碍;两个问题都在头几个月解决了。死亡率为零。该方法的特别优点是确定胼胝体切开术切口的准确轨迹和位置,可视化和避免上矢状窦,桥静脉和经常变化的胼胝体周动脉的回缩,心室系统的空间定位,以及识别心室周围解剖结构。
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引用次数: 8
Efficiency of Gamma Knife Radiosurgery in the Treatmentof Glomus Jugulare Tumors 伽玛刀放射治疗颈静脉球瘤的疗效观察
Pub Date : 2001-09-01 DOI: 10.1055/s-2001-18162
W. Saringer, H. Khayal, A. Ertl, A. Schoeggl, K. Kitz
This study was performed to assess the impact of gamma knife radiosurgery (RS) in the treatment of glomus jugulare tumors. Between February 1993 and February 1999, thirteen patients (9 women, 4 men; mean age 63.5 years, range 29 to 79 years) underwent stereotactic radiosurgery for glomus jugulare tumors with the Leksell Gamma Knife at the Neurosurgical Department of the University of Vienna. Four patients, mean age 74.5 years, range 67 to 79 years, underwent radiosurgery as the only treatment. Nine patients received radiosurgery as adjuvant therapy after previous treatment had failed: surgical resection in 9 patients and additional fractionated external beam radiation in two of these patients. Pretreatment evaluation included the staging of all tumors according to the Fisch Classification: De1 (7), De2 (1), Di1 (4) and Di2 (1). The mean follow-up period was 4.2 years, range 0.7 to 6.7 years. Ten patients, 77 %, were treated prior to 1997, the mean follow-up period being 5 years. Six patients showed no clinical changes, while six experienced an improvement of their clinical symptoms and neurological deficits. One patient was lost to follow-up. Radiation-induced transient cranial nerve neuropathies were observed in two patients. Serial MRI scans revealed tumor control in all patients, with unaltered tumor size in 10 and shrinkage in three patients. The results indicate that RS is an attractive treatment option for glomus jugulare tumors and will occupy an increasingly important role in the management of these tumors in selected patients.
本研究旨在评估伽玛刀放射手术(RS)治疗颈静脉球瘤的影响。1993年2月至1999年2月期间,13名患者(9名女性,4名男性;平均年龄63.5岁,年龄范围29 - 79岁)在维也纳大学神经外科用Leksell伽玛刀行立体定向放射治疗颈静脉球瘤。4例患者,平均年龄74.5岁,67 - 79岁,接受放射手术作为唯一治疗。9例患者在先前治疗失败后接受放射手术作为辅助治疗:9例患者手术切除,其中2例患者额外接受分次外束放疗。预处理评估包括所有肿瘤的Fisch分级:De1(7)、De2(1)、Di1(4)、Di2(1)。平均随访时间4.2年,范围0.7 ~ 6.7年。1997年以前治疗10例,占77%,平均随访5年。6例患者无临床变化,6例患者的临床症状和神经功能缺损有所改善。1例患者失访。2例患者观察到放射引起的一过性脑神经病变。连续MRI扫描显示所有患者肿瘤控制,10例肿瘤大小不变,3例肿瘤缩小。结果表明RS是颈内静脉球瘤的一种有吸引力的治疗选择,并将在这些肿瘤的治疗中发挥越来越重要的作用。
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引用次数: 78
Ultrasound-Guided Aspiration of Brain Abscesses Through a Single Burr Hole 超声引导下单孔脑脓肿穿刺
Pub Date : 2001-09-01 DOI: 10.1055/s-2001-18126
M. Strowitzkí, K. Schwerdtfeger, Steudel Wi
Surgical aspiration and/or drainage of brain abscesses is considered to be the first-line treatment for abscesses larger than 25 mm. This is ususally performed with the aid of CT-guided stereotaxy. A method of ultrasound guidance is presented that allows a single burr hole approach with real-time imaging of the whole procedure. A bayonet-like shaped ultrasound probe with tip dimension of 8 x 8 mm only (EUP-NS 32, Hitachi/Ecoscan) with frequencies of 3.5 and 5 MHz is used. After placement of a burr hole the target is identified by transdural insonation, a guideline is adjusted and a mounted puncture-adapter guides the cannula towards the lesion under real-time imaging control. Up to now 12 abscesses in 10 patients were treated. Visualization was always excellent. A second aspiration had to be performed twice. One abscess did not contain enough pus to be cured by aspiration and was removed by open surgery, another could not be tapped by the blunt cannula and was aspirated under stereotactic control using a sharp trocar. Outcome was excellent in 6 patients and fair in 2 patients but this was due to the pre-existing disease. Two patients admitted in deep coma died despite an emergency operation. The presented method has proven to be a very powerful guiding tool in the surgical treatment of brain abscesses through a single burr hole approach.
对于大于25mm的脑脓肿,手术抽吸和/或引流被认为是一线治疗方法。这通常在ct引导立体定向的帮助下进行。提出了一种超声引导的方法,允许一个单一的毛刺孔接近与实时成像的整个过程。使用卡口状超声探头,尖端尺寸仅为8 x 8 mm (EUP-NS 32,日立/Ecoscan),频率为3.5和5 MHz。在放置钻孔后,通过经硬膜超声识别目标,在实时成像控制下调整指南并安装穿刺适配器引导套管朝向病变。治疗10例12个脓肿。可视化总是很棒的。第二次抽吸必须进行两次。一例脓肿含脓量不足,无法通过抽吸治愈,并通过开放手术切除;另一例脓肿无法通过钝套管穿刺,因此在立体定向控制下使用尖锐套管针进行抽吸。6名患者的结果很好,2名患者的结果一般,但这是由于先前存在的疾病。两名深度昏迷的病人在紧急手术后死亡。所提出的方法已被证明是一个非常强大的指导工具,在外科治疗脑脓肿通过一个单一的钻孔入路。
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引用次数: 27
Epidural Metastasis of a Glioblastoma After Stereotactic Biopsy: Case Report 立体定向活检后胶质母细胞瘤硬膜外转移一例报告
Pub Date : 2001-09-01 DOI: 10.1055/s-2001-18127
M. Aichholzer1, P. Mazal2, C. Haberler3, W. Dietrich1, A. Bertalanffy1, K. Roessler1, K. Ungersboeck1
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引用次数: 18
Microsurgical Posterior Fossa Exploration for Trigeminal Neuralgia: A Study on 48 Cases 显微外科后颅窝探查治疗三叉神经痛48例分析
Pub Date : 2001-09-01 DOI: 10.1055/s-2001-18124
A. Delitala, A. Brunori, F. Chiappetta
The authors present their experience in the microsurgical treatment of trigeminal neuralgia (TGN). Over the last five years 48 patients were explored and 34 (71 %) underwent microvascular decompression (MVD) for significant arterial or venous conflicts. The remaining 14 patients (29 %) underwent partial sensory rhizotomy (PSR) because of negative intraoperative findings (simple contact or no conflict). Excellent or good immediate outcomes were achieved in 87.5 and 12.5 % of patients, respectively. Of the three severe recurrences observed during the follow-up period (24.7 months; range: 7 - 65 months), two underwent percutaneous microcompression and one posterior fossa reexploration, which revealed teflon-induced recompression. None of the PSR cases experienced incapacitating face numbness. MVD, an extremely effective procedure in the immediate post-operative period, is burdened in the long term by 20 % recurrences, the majority occurring within two years from surgery. We believe that careful intraoperative evaluation of the conflict entity could be the key to achieve a significant reduction of recurrences: overestimation of simple vascular contact of doubtful etiologic relevance, may lead to ineffective decompression and unsatisfactory results. In our opinion PSR should be preferred to percutaneous treatments in cases of negative exploration (contact or no conflict). In accordance with others we observed that section of half or less of the inferolateral "portio major" allows long-lasting pain relief and good preservation of sensory function.
作者介绍了三叉神经痛显微外科治疗的经验。在过去的五年中,48例患者被检查,34例(71%)因明显的动脉或静脉冲突接受了微血管减压(MVD)。其余14例(29%)患者因术中发现阴性(单纯接触或无冲突)而行部分感觉神经根切断术(PSR)。87.5%和12.5%的患者分别获得了极好或良好的即时结果。在随访期间观察到的3例严重复发(24.7个月;范围:7 - 65个月),2例经皮微压迫,1例后颅窝再探查,发现特氟龙诱导的再压迫。所有PSR病例均未出现失能性面部麻木。MVD是术后立即进行的一种非常有效的手术,但长期来看有20%的复发率,其中大多数发生在手术后两年内。我们认为,术中仔细评估冲突实体可能是显著减少复发率的关键:对病因相关性可疑的简单血管接触的过高估计,可能导致减压无效和不满意的结果。在我们看来,在阴性探查(接触或无冲突)的情况下,PSR应优先于经皮治疗。根据其他人的观察,我们观察到外侧“大比例”的一半或更少的部分可以持久地缓解疼痛并良好地保留感觉功能。
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引用次数: 10
Twenty Colloid Cysts - Comparison of Endoscopic and Microsurgical Management 20个胶体囊肿-内镜与显微外科治疗的比较
Pub Date : 2001-09-01 DOI: 10.1055/s-2001-18122
U. Kehler1, A. Brunori2, J. Gliemroth1, G. Nowak1, A. Delitala2, F. Chiappetta2, H. Arnold1
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引用次数: 79
Arachnoid Cysts: Entrapped Collections of Cerebrospinal Fluid Variably Communicating with the Subarachnoid Space 蛛网膜囊肿:包裹的脑脊液与蛛网膜下腔的交流变化
Pub Date : 2001-09-01 DOI: 10.1055/s-2001-18148
D. Santamarta1, F. Morales1, J. Sierra2, J. de Campos3
Despite decades of investigation and discussion of the mechanisms involved in the pathophysiology of arachnoid cysts, fundamental issues concerning these entities remain poorly defined and controversial. Cine-mode magnetic resonance imaging (MRI) has shown two patterns of cerebrospinal fluid (CSF) flow within the cavity in patients harbouring arachnoid cysts. Some cysts present a harmonic flow with a patent flow entry zone. All these patients had intermittent, non-progressive and non-localizing symptoms requiring no surgery according to our criteria. The second pattern of CSF flow is more chaotic and is characterized by the presence of swirls throughout the entire cardiac cycle. This pattern is associated with a more disabling clinical picture. Some of these patients required surgical treatment. During surgery, an endoscope was used for inspection purposes revealing, above all, that arachnoid cysts always and variably communicate with the subarachnoid space. The CSF enters the cyst either through a patent flow entry zone or through minute perforations in areas more loosely packed of the arachnoid network that behave as a flexible mesh able to modify the area of flowing CSF. The slipstreams of CSF within arachnoid cysts may not be channelled properly leading to possible damage of the surrounding brain parenchyma.
尽管对蛛网膜囊肿的病理生理机制进行了数十年的研究和讨论,但关于这些实体的基本问题仍然缺乏定义和争议。电影模式磁共振成像(MRI)显示两种模式的脑脊液(CSF)在腔内流动的病人窝藏蛛网膜囊肿。有些囊肿呈现谐波流,并有专利流进入区。根据我们的标准,所有这些患者都有间歇性、非进行性和非局域性症状,无需手术。第二种脑脊液流动模式更加混乱,其特点是在整个心脏周期中存在漩涡。这种模式与更严重的临床症状有关。其中一些患者需要手术治疗。在手术中,内窥镜用于检查目的,首先显示蛛网膜囊肿总是和可变地与蛛网膜下腔相通。脑脊液要么通过通畅的血流进入区进入囊肿,要么通过蛛网膜网络中更松散的区域的微小穿孔进入囊肿,蛛网膜网络表现为灵活的网状结构,能够改变脑脊液流动的区域。蛛网膜囊肿内的脑脊液滑流可能无法正确引导,导致周围脑实质的损伤。
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引用次数: 20
High Cervical Spinal Cord Stimulation (CSCS) Increases Regional Cerebral Blood Flow After Induced Subarachnoid Haemorrhage in Rats 高强度颈脊髓刺激(CSCS)增加大鼠蛛网膜下腔出血后脑区域血流量
Pub Date : 2001-09-01 DOI: 10.1055/s-2001-18149
H. Ebel1, K. Schomäcker2, A. Balogh3, M. Volz1, J. Funke1, H. Schicha2, N. Klug1
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引用次数: 30
Orbital Manifestation of Multiple Myeloma: Case Report 多发性骨髓瘤眼眶表现1例
Pub Date : 2001-09-01 DOI: 10.1055/s-2001-18121
E. Gönül1, Y. Izci1, M. Sefalı2, E. Erdoğan1, E. Timurkaynak1
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引用次数: 6
期刊
Minimally Invasive Neurosurgery
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