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At least 793 records · Page 44Linked to original sources
PubMed2004

[Surgical treatment of fibrous dysplasia of the skull with neuro-navagation].

OBJECTIVE: To evaluate the role and effect of neuro-navagation in the surgical treatment of fibrous dysplasia of the skull and to discuss the indication and advantages of transcranial optic nerve decompression are discussed. METHODS: Fifteen patients with fibrous dysplasia of skull, 6 males and 9 females, aged 10.3 (5 approximately 21), were surgically treated by transcranial approach. The location of lesion, symptoms and signs, CT characteristics, surgical approaches, and outcomes were analyzed. The postoperative outcomes of visual acuity were grouped into 5 categories: blindness, light perception, hand motion, counting fingers, and recognizing acuity chart. Improvement of visual acuity of one grade or more or increase of 0.1 by acuity chart, and improvement of visual field were defined as effective. RESULTS: Fibrous dysplasia of skull in children most often involved the frontal, sphenoid, and ethmoid bones and resulted in stenosis of optic canal and superior optic fissure. The most common symptoms were decreased vision, proptosis and facial asymmetry. 13 patients underwent decompression of optic canal in lateral side, and two patients in both side. All the cases had pathological diagnosis of Fibrous dysplasia of the skull. After 3-to-25-month follow-up, improvement was found in 11 eyes (65%), and no improvement was found in 6 eyes (35%). Decreased vision was not seen. CONCLUSION: Transcranial optic nerve decompression is an effective treatment for decreased vision induced by Fibrous dysplasia of the skull.

Adolescent↗
PubMed2004

CyberKnife frameless stereotactic radiosurgery for spinal lesions: clinical experience in 125 cases.

OBJECTIVE: The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited by the availability of effective target-immobilizing devices. Conventional external beam radiotherapy lacks the precision to allow delivery of large doses of radiation near radiosensitive structures such as the spinal cord. The CyberKnife (Accuray, Inc., Sunnyvale, CA) is an image-guided frameless stereotactic radiosurgery system that allows for the radiosurgical treatment of spinal lesions. This study evaluated the feasibility and effectiveness of the treatment of spinal lesions with a single-fraction radiosurgical technique using the CyberKnife. METHODS: The CyberKnife system uses the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator with six degrees of freedom that guides the therapy beam to the intended target without the use of frame-based fixation. Real-time imaging allows the tracking of patient movement. Cervical spine lesions were located and tracked relative to cranial bony landmarks; lower spinal lesions were tracked relative to fiducial bone markers. In this prospective cohort evaluation of a spine radiosurgery technique, 125 spinal lesions in 115 consecutive patients were treated with a single-fraction radiosurgery technique (45 cervical, 30 thoracic, 36 lumbar, and 14 sacral). There were 17 benign tumors and 108 metastatic lesions. All dose plans were calculated on the basis of computed tomographic images acquired from 1.25-mm slices with an inverse treatment planning technique. Radiosurgical circular cones ranging in diameter from 5 to 40 mm were used. RESULTS: Tumor volume ranged from 0.3 to 232 cm(3) (mean, 27.8 cm(3)). Seventy-eight lesions had received external beam irradiation previously. Tumor dose was maintained at 12 to 20 Gy to the 80% isodose line (mean, 14 Gy); canal volume receiving more than 8 Gy ranged from 0.0 to 1.7 cm(3) (mean, 0.2 cm(3)). No acute radiation toxicity or new neurological deficits occurred during the follow-up period (range, 9-30 mo; median, 18 mo). Axial and radicular pain improved in 74 of 79 patients who were symptomatic before treatment. CONCLUSION: This is the first large prospective evaluation of this frameless image-guided spinal radiosurgery system. The CyberKnife system was found to be feasible, safe, and effective. The major potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with rapid recovery and symptomatic response. This technique offers a successful therapeutic modality for the treatment of a variety of spinal lesions as a primary treatment or for lesions not amenable to open surgical techniques, in medically inoperable patients, in lesions located in previously irradiated sites, or as an adjunct to surgery.

Adult↗
PubMed2004

Delineation of lateral tentorial sinus with contrast-enhanced MR imaging and its surgical implications.

BACKGROUND AND PURPOSE: The lateral tentorial sinus (LTS) has not been well described in the imaging literature. The aim of this study was to investigate the value of MR imaging in assessing the LTS, which may provide guidance for preoperative planning. METHODS: Fifty-five adult patients underwent MR imaging of the brain. Four neuroradiologists evaluated the studies for delineation of the LTS and its branches. Presence of arachnoid granulation and dominance of the venous drainage also were reported. RESULTS: An LTS was detected in 104 of 110 lobes. The LTS in each lobe was classified as type I (candelabra) in 30 (28.8%), type II (independent veins) in 22 (21.1%), and type III (venous lakes) in 37 (35.5%); in 15 (14.4%) of the lobes, the LTS was indeterminate. LTS branches were inconsistently detected, with the exception of the vein of Labbé (VL). Five of eight branches were seen in approximately half of the cases. The VL was identified in 94 (85.4%) lobes. Among these, 53 (56.4%) were draining into the LTS and 22 (23.4%) into the transverse sinus; in 19 (20.2%) cases, the terminal portion was not visualized. The right transverse sinus was dominant in 19 (34.5%) patients and the left in 18 (32.7%); codomination was present in 18 (32.7%) cases. At least one arachnoid granulation was seen in the transverse sinus in 27 (49.1%) patients. CONCLUSION: In many instances, the LTS and VL drainage patterns were well delineated on routine MR images. For selected cases, this information may be crucial during lateral skull base surgery to avoid venous infarct.

Adult↗
PubMed2004

Bone cements: review of their physiochemical and biochemical properties in percutaneous vertebroplasty.

Percutaneous vertebroplasty is an effective treatment for aggressive vertebral hemangiomas, osteoporotic vertebral compression fractures, spinal metastases, and myelomas. As percutaneous vertebroplasty is more commonly performed to treat various forms of back pain, new or modified cements are being used. This review examines the physiochemical and biomechanical properties of various bone cements and additives.

Back Pain↗
PubMedDate not supplied

[Cerebral cavernomas followed by epileptic seizures: clinical picture, diagnosis, and treatment].

The clinical features of epilepsy associated with cerebral cavernomas and the results of different types of its surgical treatment: cavernonectomy, extended cavernomectomy, and epileptic focus resection were analyzed. The clinical, radiological, and electrophysiological data were studied in 48 patients with epileptic seizures associated with cerebral cavernomas who had been admitted to the Unit of Neurosurgery, Saint Anna Hospital (Paris, France) in 1982-2001. According to the severity of epileptic manifestations, the patients were divided into 2 groups: 1) 21 patients with single and rare seizures and 2) 27 patients with drug-resistant epilepsy. All the patients received medical antiepileptic therapy. Twelve patients from Group 1 underwent cavernomectomy or "extended" cavernomectomy. In Group 2, 23 patients were operated on and 3 types of operations (cavernomectomy, "extended" cavernomectomy, and corticoectomy) were performed. Statistically significant differences were found in anatomic, clinical, and electrophysiological parameters. Criteria associated with the development of drug-resistant epilepsy were established. These included: the early onset of seizures, temporal cavernoma, and a combination of partial and generalized seizures in one patient. The paper shows it necessary to choose a surgical intervention in relation to the duration of seizures, their frequency, and a response to medical antiepileptic therapy. The advantages of surgical treatment over medical one were not found in single and rare seizures (Group 1), while in drug-resistant epilepsy, surgical treatment yielded much better epileptological results than did medical treatment. The volume of a surgical intervention depends on the sizes of an epileptic focus detected by an in-depth preoperative study and on the site of a cavernoma.

Adult↗
PubMed2004

The nursing role in patient education regarding outpatient neurosurgical procedures.

The shift towards patient-centred care is the priority in health care today. Providing quality care that is highly efficient and patient-friendly while also being cost-effective is a difficult, but not impossible task. Since 1996, awake, image-guided day surgery for resection of brain tumors has been performed at Toronto Western Hospital in an attempt to combine the concept of patient-centred care with responsible resource allocation. Nurses can play a vital role in facilitating a shift in outpatient neurosurgery towards a more patient-care focused environment. By providing information and education to patients and families, nurses have enormous potential to improve satisfaction and outcomes for patients undergoing these procedures. Thoroughly preparing patients for their surgery and helping them manage their care post-operatively are the keys to decreased complications and re-admission. This would undoubtedly improve cost-effectiveness for the system while simultaneously improving the patients' quality of life.

Ambulatory Surgical Procedures↗
PubMed2004

C7 fracture treated with a pedicle screw system under navigation guidance.

A 51-year-old woman with traumatic fracture-subluxation of C6-C7 vertebrae was treated by pedicle screw fixation. Among several methods for surgical treatment of the cervical spine, this technique provides a more rigid anchor to prevent collapsing or instability of the spinal column, particularly at the cervicothoracic junction. However, the risk of injuring the adjacent neurovascular structures cannot be completely eliminated. The characteristics of the cervicothoracic junction, surgical approaches and pedicle screw fixation techniques are emphasised.

Bone Screws↗
PubMed2002

Real-time soft tissue modelling for web-based surgical simulation: SurfaceChainMail.

The Web provides a useful environment for simple surgical training simulations. A combination of VRML for 3D rendering, and Java code for the simulation engine, has been used for a range of simple neurosurgical demonstrators. However the elements in these simulators are rigid, to avoid the computational complexity of deformable modelling. In this paper we describe a variation of the ChainMail technique that allows us to provide real-time deformable modelling, even in a Web browser environment on a PC. Our new algorithm, SurfaceChainMail, has been used to develop a simulator for the cutting of two layers of tissue, and separating the layers by pulling them apart.

Algorithms↗
PubMed2002

Risk reduction in craniofacial surgery using computer-based modeling and intraoperative immersion.

We present a two-stage concept for risk reduction in craniofacial surgery, consisting of preoperative risk modeling and intraoperative risk reduction. Preoperatively it is important to find and to visualize risk sources in order to minimize them. Our risk model is composed by superimposition of an isotropic risk potential and an anisotropic tissue field constituent. It is being applied to preoperative planning and simulation of craniofacial surgeries, for example to determine an access path with least overall risk value. In the operation room risks arise mainly from the absence of preoperative planning and simulation data in the operation field. We use a see-through head-mounted display to optimize this situation in order to allow the surgeon to maintain accuracy in the whole process of computer aided surgery. Main steps of the intraoperative immersion are optical tracking of the surgeon wearing the head-mounted display and of the patient, registration of preoperatively calculated planning data with the patient and visualization of the data within the glasses.

Computer Graphics↗
PubMed2002

The DextroBeam: a stereoscopic presentation system for volumetric medical data.

This paper describes an interaction system called the DextroBeam designed for manipulating objects in 3D space while looking at a 3D stereoscopic display located in front of the user. Three-dimensional interaction is two-handed and is achieved by means of a stylus with a single button or switch. We have been planning several neurosurgical cases with the DextroBeam, including the separation of Nepalese Siamese twins in April 2001, and have conducted a course on surgery of the Temporal Bone (as part of the 9th ASEAN ORL Head and Neck Congress in Singapore, March 2001).

Brain↗
PubMed2005

[New development of surgical treatment for malignant brain tumors].

The most important prognosticator for malignant brain tumor patients is the degree of tumor removal. On the other hand, surgical removal should not induce aggravation of the patient performance status. In accordance with the result, surgical planning for glioma should be carefully considered. However, there is no standard guide for preoperative planning to date. However, there is no standard guide for preoperative planning to the present. We attempted to divide gliomas into 5 stages according to the difficulty of the surgery and analyzed the relation between the removal rate and each stage. The results demonstrated that the stage is correlated with the removal rate. This staging might contribute to standardization of glioma surgery. For surgical planning of tumors around the motor area, fiber tractography and magnetoencephalography should be very useful. As an intraoperative examination, monitoring of motor evoked potential is necessary to resect tumors around the motor area. For resection of tumors around the speech area, functional brain mapping under awake surgery is the most reliable method. In addition to these techniques for safe surgery, neuro-navigation and chemical navigation using 5-aminolevulinic acid are used to achieve of the maximum removal rate. Finally, development of preoperative examinations, microsurgical technique, and intraoperative monitoring enabled us to do safer and move sure surgery.

Astrocytoma↗
PubMed2005

[Application of intraoperative real-time ultrasound in the surgical treatment of cerebral arteriovenous malformation].

OBJECTIVE: To investigate the value of intraoperative real-time ultrasound during surgery of cerebral arteriovenous malformations (AVMs). METHODS: Thirteen patients with cerebral AVMs, 12 supratentorial and 1 infratentorial, underwent microsurgical treatment. Intraoperative ultrasound (IOUS) with multimodality was performed before the starting of resection in order to: (1) localize and delineate the AVM, (2) differentiate the embolized and perfused parts of AVM, and (3) identify the feeding arteries and draining veins. After removal of the lesion, sonographic examination was repeated to detect the residual AVM tissue and the findings were compared with the intra- and/or post-operative angiographic finding. RESULTS: Total resection was achieved in all 13 patients with AVM under real-time ultrasonographic navigation. The niduses of AVM were localized and defined precisely by IOUS due to their dichromatic flow pattern. The embolized parts of AVM exhibited hyperechogenicity without blood signals. The feeding and draining vessels were distinguished from normal ones morphologically and hemodynamically. Complete removal of the AVM determined sonographically was then confirmed by angiography. CONCLUSIONS: Intraoperative real-time ultrasound allows accurate localization and navigation of the cerebral AVMs, provides valuable information during surgery, and helps determine the degree of removal of the cerebral AVM.

Adolescent↗