Pub Date : 2010-10-01Epub Date: 2011-02-07DOI: 10.1055/s-0030-1269873
A Sadato, S Maeda, M Hayakawa, Y Kato, H Sano, Y Hirose, S Miyamoto, N Hashimoto
Objective: There are various options for the treatment of vertebral artery dissection aneurysms (VADA). Treatment with stents may be an effective method to treat VADA involving the posterior inferior cerebellar artery (PICA) and dissection of the dominant vertebral artery (VA). In this article, our personal experience of the treatment of VADAs by using stents and coils is reported.
Methods: Since 1998, 26 cases of VADA have been treated by endovascular surgery by the first author. Of these cases, 6 cases were treated using stents, 3 of which were treated using stent and coils, 2 patients were treated using double overlapping stents, and the remaining one patient was treated using a single stent.
Results: In all patients, dissection aneurysms were successfully covered by stents. There was one complication: an intraprocedural rupture during additional coil insertion without neurological deterioration. Follow-up angiography was performed in all 5 surviving patients except for one patient who died due to the severity of his original subarachnoid hemorrhage (mean duration of follow-up angiography 22.8 months, range 15-57 months). Total or subtotal disappearance of the VADA was achieved in all 5 cases. At one year after the treatment, all 5 surviving patients remained clinically stable without any neurological deficit.
Conclusions: Treatment using stents is an effective alternative for the treatment of VA dissecting aneurysms, especially for lesions of the dominant VA or involving the PICA. However, additional coil insertion should be performed very carefully and may be avoided if stagnation of contrast material is achieved after overlapping stenting.
{"title":"Endovascular treatment of vertebral artery dissection using stents and coils: its pitfall and technical considerations.","authors":"A Sadato, S Maeda, M Hayakawa, Y Kato, H Sano, Y Hirose, S Miyamoto, N Hashimoto","doi":"10.1055/s-0030-1269873","DOIUrl":"https://doi.org/10.1055/s-0030-1269873","url":null,"abstract":"<p><strong>Objective: </strong>There are various options for the treatment of vertebral artery dissection aneurysms (VADA). Treatment with stents may be an effective method to treat VADA involving the posterior inferior cerebellar artery (PICA) and dissection of the dominant vertebral artery (VA). In this article, our personal experience of the treatment of VADAs by using stents and coils is reported.</p><p><strong>Methods: </strong>Since 1998, 26 cases of VADA have been treated by endovascular surgery by the first author. Of these cases, 6 cases were treated using stents, 3 of which were treated using stent and coils, 2 patients were treated using double overlapping stents, and the remaining one patient was treated using a single stent.</p><p><strong>Results: </strong>In all patients, dissection aneurysms were successfully covered by stents. There was one complication: an intraprocedural rupture during additional coil insertion without neurological deterioration. Follow-up angiography was performed in all 5 surviving patients except for one patient who died due to the severity of his original subarachnoid hemorrhage (mean duration of follow-up angiography 22.8 months, range 15-57 months). Total or subtotal disappearance of the VADA was achieved in all 5 cases. At one year after the treatment, all 5 surviving patients remained clinically stable without any neurological deficit.</p><p><strong>Conclusions: </strong>Treatment using stents is an effective alternative for the treatment of VA dissecting aneurysms, especially for lesions of the dominant VA or involving the PICA. However, additional coil insertion should be performed very carefully and may be avoided if stagnation of contrast material is achieved after overlapping stenting.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1269873","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29656271","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}
Pub Date : 2010-10-01Epub Date: 2011-02-07DOI: 10.1055/s-0030-1263125
L Dörner, B Petersen, H M Mehdorn, A Nabavi
Objective: The aim of this report is to illustrate a method for the precise placement of chemotherapeutic delivery catheters with the aid of computer-assisted navigation systems.
Materials and methods: We have developed a cannula which can be referenced to our navigation system (BrainLab (®)) to advance and position catheters. The cannula has a length of 10 cm. In the case of a ventricular puncture, CSF will drain through holes at the tip and a side port of the cannula to caution the surgeon. The cannula is fixed to the BrainLab (®) adapter ML and navigated with a BrainLab (®) vector vision (®) system. Using the puncture software, the placement is planned and executed. After placing the cannula as planned, the mandrin is removed and the primed catheter moved forward. When resistance is felt the cannula is withdrawn over the catheter. Further catheters can be placed similarly.
Results: Initial phantom tests showed a good target accuracy. Clinically we have used the cannula in 7 cases with good accuracy.
Conclusion: This newly designed tool is easy to handle and well integrated into the navigation system. It provides the means to place catheters precisely to the planned position. Potentially it can be combined with every navigation system using adaptable reference systems.
{"title":"A new tool for the navigated placement of intracerebral chemotherapy catheters.","authors":"L Dörner, B Petersen, H M Mehdorn, A Nabavi","doi":"10.1055/s-0030-1263125","DOIUrl":"https://doi.org/10.1055/s-0030-1263125","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this report is to illustrate a method for the precise placement of chemotherapeutic delivery catheters with the aid of computer-assisted navigation systems.</p><p><strong>Materials and methods: </strong>We have developed a cannula which can be referenced to our navigation system (BrainLab (®)) to advance and position catheters. The cannula has a length of 10 cm. In the case of a ventricular puncture, CSF will drain through holes at the tip and a side port of the cannula to caution the surgeon. The cannula is fixed to the BrainLab (®) adapter ML and navigated with a BrainLab (®) vector vision (®) system. Using the puncture software, the placement is planned and executed. After placing the cannula as planned, the mandrin is removed and the primed catheter moved forward. When resistance is felt the cannula is withdrawn over the catheter. Further catheters can be placed similarly.</p><p><strong>Results: </strong>Initial phantom tests showed a good target accuracy. Clinically we have used the cannula in 7 cases with good accuracy.</p><p><strong>Conclusion: </strong>This newly designed tool is easy to handle and well integrated into the navigation system. It provides the means to place catheters precisely to the planned position. Potentially it can be combined with every navigation system using adaptable reference systems.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1263125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29656278","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}
Pub Date : 2010-10-01Epub Date: 2011-02-07DOI: 10.1055/s-0030-1267232
U Godano, R Ferrai, V Meleddu, M Bellinzona
Background: Third ventricle colloid cysts are regarded as benign lesions. They may, however, present with dramatic and rapidly deteriorating neurological signs, leading to sudden death. Although the exact cause of this clinical course is unknown, acute hydrocephalus caused by occlusion of Monro's foramina has been suggested. This, in turn, may be the result of acute cyst swelling, which can exceptionally be due to an intralesional hemorrhage.
Case report: This report illustrates the case of a young patient who deteriorated to sudden coma and was found to have a hemorrhagic colloid cyst of the third ventricle. This was removed via a purely endoscopic technique. Although the radiological results were excellent, the clinical outcome was poor.
Conclusions: This case suggests once again the importance of the early recognition of colloid cysts of the third ventricle for appropriate treatment before potentially irreversible neurological deterioration sets in.
{"title":"Hemorrhagic colloid cyst with sudden coma.","authors":"U Godano, R Ferrai, V Meleddu, M Bellinzona","doi":"10.1055/s-0030-1267232","DOIUrl":"https://doi.org/10.1055/s-0030-1267232","url":null,"abstract":"<p><strong>Background: </strong>Third ventricle colloid cysts are regarded as benign lesions. They may, however, present with dramatic and rapidly deteriorating neurological signs, leading to sudden death. Although the exact cause of this clinical course is unknown, acute hydrocephalus caused by occlusion of Monro's foramina has been suggested. This, in turn, may be the result of acute cyst swelling, which can exceptionally be due to an intralesional hemorrhage.</p><p><strong>Case report: </strong>This report illustrates the case of a young patient who deteriorated to sudden coma and was found to have a hemorrhagic colloid cyst of the third ventricle. This was removed via a purely endoscopic technique. Although the radiological results were excellent, the clinical outcome was poor.</p><p><strong>Conclusions: </strong>This case suggests once again the importance of the early recognition of colloid cysts of the third ventricle for appropriate treatment before potentially irreversible neurological deterioration sets in.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1267232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29656276","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}
Pub Date : 2010-10-01Epub Date: 2011-02-07DOI: 10.1055/s-0030-1267925
K K Gnanalingham, M B Afridi, A Abou-Zeid, A Herwadkar
Introduction: Vertebral haemangiomas are a common incidental finding and are largely asymptomatic. Extensive haemangiomas of the spine causing neurological deficits are exceedingly rare. Traditional open surgical approaches in these cases can be complicated by life-threatening blood loss.
Patient case history: We describe 2 patients (ages 27 and 53 years) who presented with severe back pain and lower limb weakness. Radiological investigations revealed very extensive lesions of the L1 and L4 vertebral bodies, respectively, with severe narrowing of the lumbar canal. After selective embolisation of the spinal arterial feeders, both patients underwent a posterior decompression, vertebroplasty, and bilateral pedicle screw fixation in a minimally invasive fashion. Blood loss was minimal and a rapid clinical recovery was seen.
Conclusions: Combinations of embolisation, vertebroplasty and minimally invasive posterolateral instrumentation are treatment strategies that can be used to treat extensive vertebral haemangiomas presenting with neurological deficits.
{"title":"Minimally invasive decompression and stabilisation for extensive haemangiomas of lumbar spine.","authors":"K K Gnanalingham, M B Afridi, A Abou-Zeid, A Herwadkar","doi":"10.1055/s-0030-1267925","DOIUrl":"https://doi.org/10.1055/s-0030-1267925","url":null,"abstract":"<p><strong>Introduction: </strong>Vertebral haemangiomas are a common incidental finding and are largely asymptomatic. Extensive haemangiomas of the spine causing neurological deficits are exceedingly rare. Traditional open surgical approaches in these cases can be complicated by life-threatening blood loss.</p><p><strong>Patient case history: </strong>We describe 2 patients (ages 27 and 53 years) who presented with severe back pain and lower limb weakness. Radiological investigations revealed very extensive lesions of the L1 and L4 vertebral bodies, respectively, with severe narrowing of the lumbar canal. After selective embolisation of the spinal arterial feeders, both patients underwent a posterior decompression, vertebroplasty, and bilateral pedicle screw fixation in a minimally invasive fashion. Blood loss was minimal and a rapid clinical recovery was seen.</p><p><strong>Conclusions: </strong>Combinations of embolisation, vertebroplasty and minimally invasive posterolateral instrumentation are treatment strategies that can be used to treat extensive vertebral haemangiomas presenting with neurological deficits.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1267925","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29656277","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":"We would like to thank the following persons who reviewed MIN manuscripts for their expertise and support in the year 2010:","authors":"","doi":"10.1055/s-0030-1271672","DOIUrl":"https://doi.org/10.1055/s-0030-1271672","url":null,"abstract":"","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84060028","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}
Pub Date : 2010-10-01Epub Date: 2011-02-07DOI: 10.1055/s-0030-1269874
R Bernard, F Vallee, J Mateo, M Marsella, B George, D Payen, S Chibbaro
Background: Endoscopic third ventriculostomy (ETV) is considered a safe procedure although it carries its rate of risks and complications that may occasionally be life-threatening.
Case report: This is a report about a 48-year-old woman presenting with progressive gait unsteadiness, weakness of the lower extremities and cognitive impairment due to tri-ventricular hydrocephalus. This was treated with standard ETV. In the immediate post-operative period the patient developed a severe and uncontrollable tachypnea requiring sedation, intubation and mechanical ventilation.
Conclusion: Tachypnea may be an early complication after standard ETV and although its mechanism remains yet unclear, we speculate that it may be related to excessive traction and/or surgical manipulation of the floor of the third ventricle. Supportive care with mechanical ventilation is the mainstay of treatment until spontaneous normalization of the respiratory mechanism occurs.
{"title":"Uncontrollable high-frequency tachypnea: a rare and nearly fatal complication of endoscopic third ventriculostomy: case report and literature review.","authors":"R Bernard, F Vallee, J Mateo, M Marsella, B George, D Payen, S Chibbaro","doi":"10.1055/s-0030-1269874","DOIUrl":"https://doi.org/10.1055/s-0030-1269874","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic third ventriculostomy (ETV) is considered a safe procedure although it carries its rate of risks and complications that may occasionally be life-threatening.</p><p><strong>Case report: </strong>This is a report about a 48-year-old woman presenting with progressive gait unsteadiness, weakness of the lower extremities and cognitive impairment due to tri-ventricular hydrocephalus. This was treated with standard ETV. In the immediate post-operative period the patient developed a severe and uncontrollable tachypnea requiring sedation, intubation and mechanical ventilation.</p><p><strong>Conclusion: </strong>Tachypnea may be an early complication after standard ETV and although its mechanism remains yet unclear, we speculate that it may be related to excessive traction and/or surgical manipulation of the floor of the third ventricle. Supportive care with mechanical ventilation is the mainstay of treatment until spontaneous normalization of the respiratory mechanism occurs.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1269874","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29656275","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}
Pub Date : 2010-10-01Epub Date: 2011-02-07DOI: 10.1055/s-0030-1263105
I Dallan, R Lenzi, M Bignami, P Battaglia, S Sellari-Franceschini, L Muscatello, V Seccia, P Castelnuovo, M Tschabitscher
Background: The aim of this study was to illustrate the endoscopic surgical anatomy of the infratemporal fossa (ITF) and upper parapharyngeal space and to provide useful landmarks by comparing transnasal perspectives with external ones.
Materials and methods: 6 fresh double injected heads were dissected. External lateral dissection was performed through a pre-auricular skin incision while external anterior dissection started with a modified Weber-Ferguson incision. External medial to lateral dissection was performed starting from the rhinopharyngeal and pterygoid regions, after cutting the specimen in 2 halves passing through the nose. Endoscopic dissection was performed through an endonasal approach (0° and 45° scopes).
Results: Among all the structures identified during the dissection, the most useful landmark when dissecting the ITF in a lateral to medial direction is the lateral pterygoid muscle. In anterior approaches (mostly endoscopic) the role of the lateral pterygoid muscle is less important and the Eustachian tube (ET) represents the most important landmark to point out the upper portion of the parapharyngeal internal carotid artery (ICA). The role of the ET, in lateral dissection is, on the contrary, by far less important given the fact that it is very deep in the surgical field and that the ICA is encountered earlier during surgical approaches. Another crucial landmark during anterior endoscopic surgery is the vidian nerve because it points to the anterior genu of the internal carotid artery.
Conclusion: The complex 3-dimensionality of the ITF and the upper parapharyngeal space needs a sound knowledge of the surgical anatomy. The role of the same landmarks changed in different approaches. The ability to orientate oneself in this complex area is related to an accurate knowledge of its anatomy through comparison of endoscopic and external perspectives.
{"title":"Endoscopic transnasal anatomy of the infratemporal fossa and upper parapharyngeal regions: correlations with traditional perspectives and surgical implications.","authors":"I Dallan, R Lenzi, M Bignami, P Battaglia, S Sellari-Franceschini, L Muscatello, V Seccia, P Castelnuovo, M Tschabitscher","doi":"10.1055/s-0030-1263105","DOIUrl":"https://doi.org/10.1055/s-0030-1263105","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to illustrate the endoscopic surgical anatomy of the infratemporal fossa (ITF) and upper parapharyngeal space and to provide useful landmarks by comparing transnasal perspectives with external ones.</p><p><strong>Materials and methods: </strong>6 fresh double injected heads were dissected. External lateral dissection was performed through a pre-auricular skin incision while external anterior dissection started with a modified Weber-Ferguson incision. External medial to lateral dissection was performed starting from the rhinopharyngeal and pterygoid regions, after cutting the specimen in 2 halves passing through the nose. Endoscopic dissection was performed through an endonasal approach (0° and 45° scopes).</p><p><strong>Results: </strong>Among all the structures identified during the dissection, the most useful landmark when dissecting the ITF in a lateral to medial direction is the lateral pterygoid muscle. In anterior approaches (mostly endoscopic) the role of the lateral pterygoid muscle is less important and the Eustachian tube (ET) represents the most important landmark to point out the upper portion of the parapharyngeal internal carotid artery (ICA). The role of the ET, in lateral dissection is, on the contrary, by far less important given the fact that it is very deep in the surgical field and that the ICA is encountered earlier during surgical approaches. Another crucial landmark during anterior endoscopic surgery is the vidian nerve because it points to the anterior genu of the internal carotid artery.</p><p><strong>Conclusion: </strong>The complex 3-dimensionality of the ITF and the upper parapharyngeal space needs a sound knowledge of the surgical anatomy. The role of the same landmarks changed in different approaches. The ability to orientate oneself in this complex area is related to an accurate knowledge of its anatomy through comparison of endoscopic and external perspectives.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1263105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29656274","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}
Pub Date : 2010-10-01Epub Date: 2011-02-07DOI: 10.1055/s-0030-1268414
H Ishihara, S Ishihara, H Neki, M Okawara, R Kanazawa, S Kohyama, F Yamane, S Shibazaki, S Maesaki, G Hashikita
Objective: Endovascular treatments are minimally invasive and rarely cause complicating infections. Although cases complicated by device infections have been reported, we could not find any studies evaluating infections following neuroendovascular treatment in particular. Therefore, we assessed the frequency of sepsis and other associated risk factors.
Methods: From September 2006 to May 2008, we investigated 256 prospective neuroendovascular treatment cases at our facility. We examined the frequency of sepsis and other associated risk factors as well as organisms and the early detection tests such as various cultures and serodiagnoses.
Results: The rate of sepsis due to complications was 8.6% in the aggregate and 5.7% in 193 procedures without a central venous catheter and hemodialysis. All sepsis cases were successfully treated with antibiotics. However, in 2 cases, the patients developed methicillin-resistant STAPHYLOCOCCUS AUREUS infections, which were intractable. The highest risk factors for sepsis were a large sheath size [>7 F; OR =5.03; P =0.01; 95% confidence interval (CI) 1.29-19.47] and meningioma embolization (OR =13.25; P =0.04; 95% CI 1.07-163.56). The degree to which experienced staff (OR =0.09; P =0.05; 95% CI 0.09-0.97) affected the incidence of sepsis was less significant. Microorganisms were isolated from half the operating field, and the risk factor, in this case, depended on inexperienced surgical staff (OR =1.98; P =0.03; 95% CI 1.07-3.67). Although we were unable to find a means to predict sepsis, we presumed antibiotic prophylaxis would be useful.
Conclusions: The frequency of sepsis following neuroendovascular treatment is high. We should pay particular attention to the sterilization process and the operating field when undertaking neuroendovascular treatment that requires the use of a large-size sheath in patients with serious conditions.
目的:血管内治疗具有微创性,很少引起并发症。虽然有病例合并器械感染的报道,但我们没有发现任何评估神经血管内治疗后感染的研究。因此,我们评估了脓毒症的发生频率和其他相关危险因素。方法:从2006年9月到2008年5月,我们调查了256例神经血管内治疗的患者。我们检查了脓毒症的频率和其他相关的危险因素,以及微生物和早期检测测试,如各种培养和血清诊断。结果:在193例无中心静脉导管和血液透析的手术中,并发症引起的脓毒症发生率为8.6%,5.7%。所有败血症病例均成功应用抗生素治疗。但2例患者发生耐甲氧西林金黄色葡萄球菌感染,难治性。脓毒症的最高危险因素是鞘大[>7 F];或= 5.03;P = 0.01;95%可信区间(CI) 1.29-19.47)和脑膜瘤栓塞(OR =13.25;P = 0.04;95% ci 1.07-163.56)。经验丰富的员工(OR =0.09;P = 0.05;95% CI 0.09-0.97)对脓毒症发生率的影响较小。一半的手术区域分离出微生物,在这种情况下,危险因素取决于缺乏经验的手术人员(OR =1.98;P = 0.03;95% ci 1.07-3.67)。虽然我们无法找到预测败血症的方法,但我们认为抗生素预防是有用的。结论:神经血管内治疗后脓毒症发生率高。在对病情严重的患者进行需要使用大尺寸鞘的神经血管内治疗时,应特别注意灭菌过程和手术范围。
{"title":"Frequency and risk factors for sepsis resulting from neuroendovascular treatment.","authors":"H Ishihara, S Ishihara, H Neki, M Okawara, R Kanazawa, S Kohyama, F Yamane, S Shibazaki, S Maesaki, G Hashikita","doi":"10.1055/s-0030-1268414","DOIUrl":"https://doi.org/10.1055/s-0030-1268414","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular treatments are minimally invasive and rarely cause complicating infections. Although cases complicated by device infections have been reported, we could not find any studies evaluating infections following neuroendovascular treatment in particular. Therefore, we assessed the frequency of sepsis and other associated risk factors.</p><p><strong>Methods: </strong>From September 2006 to May 2008, we investigated 256 prospective neuroendovascular treatment cases at our facility. We examined the frequency of sepsis and other associated risk factors as well as organisms and the early detection tests such as various cultures and serodiagnoses.</p><p><strong>Results: </strong>The rate of sepsis due to complications was 8.6% in the aggregate and 5.7% in 193 procedures without a central venous catheter and hemodialysis. All sepsis cases were successfully treated with antibiotics. However, in 2 cases, the patients developed methicillin-resistant STAPHYLOCOCCUS AUREUS infections, which were intractable. The highest risk factors for sepsis were a large sheath size [>7 F; OR =5.03; P =0.01; 95% confidence interval (CI) 1.29-19.47] and meningioma embolization (OR =13.25; P =0.04; 95% CI 1.07-163.56). The degree to which experienced staff (OR =0.09; P =0.05; 95% CI 0.09-0.97) affected the incidence of sepsis was less significant. Microorganisms were isolated from half the operating field, and the risk factor, in this case, depended on inexperienced surgical staff (OR =1.98; P =0.03; 95% CI 1.07-3.67). Although we were unable to find a means to predict sepsis, we presumed antibiotic prophylaxis would be useful.</p><p><strong>Conclusions: </strong>The frequency of sepsis following neuroendovascular treatment is high. We should pay particular attention to the sterilization process and the operating field when undertaking neuroendovascular treatment that requires the use of a large-size sheath in patients with serious conditions.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1268414","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29656272","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}
Pub Date : 2010-10-01Epub Date: 2011-02-07DOI: 10.1055/s-0030-1267973
F H Ebner, F Roser, F Thaher, J Schittenhelm, M Tatagiba
Background: We report about endoscope-assisted surgery of epidermoid cysts in the posterior fossa focusing on the application of neuro-endoscopy and the clinical outcome in cases of recurrent epidermoid cysts.
Material and methods: 25 consecutively operated patients with an epidermoid cyst in the posterior fossa were retrospectively analysed. Surgeries were performed both with an operating microscope (OPMI Pentero or NC 4, Zeiss Company, Oberkochen, Germany) and endoscopic equipment (4 mm rigid endoscopes with 30° and 70° optics; Karl Storz Company, Tuttlingen, Germany) under continuous intraoperative monitoring. Surgical reports and DVD-recordings were evaluated for identification of adhesion areas and surgical details.
Results: 7 (28%) of the 25 patients were recurrences of previously operated epidermoid cysts. Mean time to recurrence was 17 years (8-22 years). In 5 cases the endoscope was used as an adjunctive tool for inspection/endoscope-assisted removal of remnants. The effective time of use of the endoscope was limited to the end stage of the procedure, but was very effective.
Conclusion: In a modern operative setting and with the necessary surgical experience recurrent epidermoid cysts may be removed with excellent clinical results. The combined use of microscope and endoscope offers relevant advantages in demanding anatomic situations.
{"title":"Balancing the shortcomings of microscope and endoscope: endoscope-assisted technique in microsurgical removal of recurrent epidermoid cysts in the posterior fossa.","authors":"F H Ebner, F Roser, F Thaher, J Schittenhelm, M Tatagiba","doi":"10.1055/s-0030-1267973","DOIUrl":"https://doi.org/10.1055/s-0030-1267973","url":null,"abstract":"<p><strong>Background: </strong>We report about endoscope-assisted surgery of epidermoid cysts in the posterior fossa focusing on the application of neuro-endoscopy and the clinical outcome in cases of recurrent epidermoid cysts.</p><p><strong>Material and methods: </strong>25 consecutively operated patients with an epidermoid cyst in the posterior fossa were retrospectively analysed. Surgeries were performed both with an operating microscope (OPMI Pentero or NC 4, Zeiss Company, Oberkochen, Germany) and endoscopic equipment (4 mm rigid endoscopes with 30° and 70° optics; Karl Storz Company, Tuttlingen, Germany) under continuous intraoperative monitoring. Surgical reports and DVD-recordings were evaluated for identification of adhesion areas and surgical details.</p><p><strong>Results: </strong>7 (28%) of the 25 patients were recurrences of previously operated epidermoid cysts. Mean time to recurrence was 17 years (8-22 years). In 5 cases the endoscope was used as an adjunctive tool for inspection/endoscope-assisted removal of remnants. The effective time of use of the endoscope was limited to the end stage of the procedure, but was very effective.</p><p><strong>Conclusion: </strong>In a modern operative setting and with the necessary surgical experience recurrent epidermoid cysts may be removed with excellent clinical results. The combined use of microscope and endoscope offers relevant advantages in demanding anatomic situations.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1267973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29655204","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}
Background: Stereotactic radiosurgery is an attractive option for elderly patients and those who do not tolerate the more invasive surgical procedures available for trigeminal neuralgia (TN). In the majority of the studies, the target location was designated as the proximal nerve at the root entry zone (REZ). The purpose of this article was to evaluate the efficacy of and complications associated with X-knife stereotactic radiosurgery on the trigeminal ganglion (TG) for TN.
Patients and methods: 40 patients with typical idiopathic TN were treated with X-knife. The maximum radiation dose was 70 Gy. A 4-mm collimator and a 9-arc technique were employed. Treatment was focused at the TG.
Results: At the last follow-up (mean follow-up period: 7.9 months, range: 1-19 months), pain relief for all patients was excellent in 16 (40%), good in 17 (42.5%), for a total success rate of 82.8%. The mean time to initial relief was 12.5 days ranging from immediate in onset (<24 h) to 2 months. One patient (3.0%) experienced some recurrent pain. 3 patients (7.5%) experienced noticeable subjective facial numbness. Hearing impairment was found in 1 patient (2.5%), and ulceration of the temporal skin was seen in 2 patients (5%).
Conclusion: Similar to other TN radiosurgery reports, X-knife stereotactic radiosurgery for TN provides effective pain relief with a low complication rate.
{"title":"X-knife stereotactic radiosurgery on the trigeminal ganglion to treat trigeminal neuralgia: a preliminary study.","authors":"M-J Chen, Z-Y Shao, W-J Zhang, Z-H Wang, W-H Zhang, H-S Hu","doi":"10.1055/s-0030-1269926","DOIUrl":"https://doi.org/10.1055/s-0030-1269926","url":null,"abstract":"<p><strong>Background: </strong>Stereotactic radiosurgery is an attractive option for elderly patients and those who do not tolerate the more invasive surgical procedures available for trigeminal neuralgia (TN). In the majority of the studies, the target location was designated as the proximal nerve at the root entry zone (REZ). The purpose of this article was to evaluate the efficacy of and complications associated with X-knife stereotactic radiosurgery on the trigeminal ganglion (TG) for TN.</p><p><strong>Patients and methods: </strong>40 patients with typical idiopathic TN were treated with X-knife. The maximum radiation dose was 70 Gy. A 4-mm collimator and a 9-arc technique were employed. Treatment was focused at the TG.</p><p><strong>Results: </strong>At the last follow-up (mean follow-up period: 7.9 months, range: 1-19 months), pain relief for all patients was excellent in 16 (40%), good in 17 (42.5%), for a total success rate of 82.8%. The mean time to initial relief was 12.5 days ranging from immediate in onset (<24 h) to 2 months. One patient (3.0%) experienced some recurrent pain. 3 patients (7.5%) experienced noticeable subjective facial numbness. Hearing impairment was found in 1 patient (2.5%), and ulceration of the temporal skin was seen in 2 patients (5%).</p><p><strong>Conclusion: </strong>Similar to other TN radiosurgery reports, X-knife stereotactic radiosurgery for TN provides effective pain relief with a low complication rate.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1269926","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29655205","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}