The Mini-Spheno-Supraorbital Craniotomy for Treatment of Ruptured Anterior Circulation Aneurysms.

Yasargil introduced the pterional approach mainly for clipping of anterior circulation (AC) aneurysms. We implemented the mini-spheno-supraorbital (MSS) craniotomy, changing the shape and reducing the size of the classical pterional craniotomy. The literature on clipping ruptured AC aneurysms through reduced-in-size craniotomies is sparse.

Vertigo: Could this Symptom Indicate the Existence of an Unruptured Intracranial Aneurysm?

Unruptured intracranial aneurysms (UIAs) can be presented with various symptoms, including atypical headaches and cranial nerve deficits. Vertigo is often referred in the literature as a coexisting symptom. Our aim was to investigate the importance of vertigo in the UIA symptomatology and present a possible explanation for its existence.

Surgical complications of hyperglycaemia.

We review the mechanisms leading to hyperglycaemic damage and draw functional extrapolations aiming to an improved management of surgical complications, which are common among diabetic patients.

Intracranial falx chondroma: literature review and a case report.

Intracranial chondromas are benign tumors that represent approximately 0.5% of all intracranial tumors. They usually occur at the base of the skull but on rare occasions might present as intra-parenchymal or intra-ventricular space-occupying lesions, most likely originating from heterotopic chondrocytes or metaplastic fibroblasts of the falx, the convexity dura, or the ventricular ependyma.

Primary spinal intradural extramedullary cysticercosis.

Background: Spinal cysticercosis represents an uncommon localization of a common parasitic disease and, in most cases, is associated with intracranial involvement. Once confirmed, the entire neuraxis should be evaluated.

Case Description: We present an unusual case of a 60-year-old male patient with isolated localization of spinal intradural extramedullary cysticercosis.

[Stereotactic radiosurgery in neurosurgery].

Gamma-knife stereotactic radiosurgery offers a broad spectrum armamentarium for the safe treatment of various lesions within the central nervous system. It is widely used for treatment of metastastic brain tumors, non respectable tumours, residual or recurrent benign and malignant tumors as well as for treatment of arteriovenous malformations, functional diseases and pain disorders. It is less invasive than most other surgical methods and also cost effective compared to surgical methods and other radiation treatments.

Transclival decompression of brainstem from a compressing coiled aneurysm of the midbasilar artery.

The authors present the case of a young woman, suffering from progressive tetraplegia, cranial nerve dysfunction, respiratory failure and lethargy due to radiographically demonstrated increased brainstem compression after coil embolization of an aneurysm of the midportion of the basilar artery. The patients condition improved dramatically after transclival decompression. The importance of understanding the effects of a rigid endovascular mass on adjacent neural structures is emphasized.

[Transcranial Doppler in neurosurgery. A non-invasive method in the diagnosis of vasospasm and subarachnoid hemorrhage].

Transcranial Doppler (TCD) sonography, a noninvasive method to record cerebral blood flow velocity, is increasingly being used to predict the development of a delayed ischemic deficit after subarachnoid hemorrhage. Advantages and limitations of the TCD technique in neurosurgical practice are discussed.

Intermittent cervical traction for cervical radiculopathy caused by large-volume herniated disks.

Objective: To describe the use of intermittent cervical traction in managing 4 patients with cervical radiculopathy and large-volume herniated disks.

Clinical Features: Four patients had neck pain radiating to the arm. The clinical examination was typical in all cases for radiculopathy of cervical origin.

Carbamazepine levels in the hair of patients under long-term treatment: a preliminary study.

Carbamazepine (CBZ) levels in the scalp hair of seventeen patients (ten male and seven female), aged from five to forty years old, receiving the drug systematically were determined after hair dissolution and solid-phase extraction procedures using both immunoassay (Abbott TDx) and gas chromatographic (GC) techniques. Carbamazepine levels in hair ranged from 13.9 to 66.

Open thrombectomy combined with thrombolysis in massive intracranial sinus thrombosis.

A case of complete thrombosis of the superior sagittal sinus in a pregnant women with multiple haemorrhages and hydrocephalus is described. Due to acute onset and progressive neurological deterioration, the decision was taken to remove the clot surgically. A sinotomy was performed removing the thrombotic material followed by local infusion of tissue plasminogen activator (t-PA).

CT showing early ventricular dilatation after subarachnoidal hemorrhage.

We performed a retrospective analysis of 398 patients with subarachnoidal hemorrhage (SAH) confirmed by CT. On the first CT examination the temporal horns were enlarged in 84%, the frontal horns in 32%, and the third ventricle in 21% of the patients. The amount of blood in the basal cisterns was highly correlated to dilatation of the temporal horns.

Reconstruction of craniotomy burr-holes with autologous bone blugs made by a new hole-saw.

A new craniotomy tool is described. The original De Martell drill was redesigned into a hole-saw for simultaneous production of burr-holes and appropriate autologous bone plugs. The plugs can easily be reinserted and locked in place using bone dust and Tiseel glue permitting appropriate healing and satisfactory cosmetic appearance.

New microsurgical suction tubes.

A set of new suitable microsurgical suction tubes has been designed especially suitable for fragile and delicate tissues such as the nervous and vascular tissues in the brain and spinal cord. The set provides two different shafts and five different tubes for superficial of deep micro- as well as macro-operations. These new suction tubes have two major advantages compared to traditional suction tubes.

Motor and sensory fibers of the superior laryngeal nerve in the rat. A light and electron microscopic study.

A quantitative and qualitative study of the superior laryngeal nerve (SLN) and its branches was performed on the intact nerve and after experimental denervation procedures. The distribution patterns of the myelinated fibers of the intact internal (SLNI) and external (SLNE) branches in the rat were unimodal with a fiber diameter range of 0.5-12 microns and with peaks at 2-4 microns.

The use of ultrasonic aspirator, Sonocut, for removal of brain tumours. Analysis of 26 consecutive cases.

Since the introduction of the ultrasonic aspirator system in 1978, there have been several reports on its efficacy and safety in neurosurgery. During the last six months we have used in our department the swedish manufactured device Sonocut for removal of various tumours within the central nervous system. Its benefits and limitations are discussed.

Neurotoxicity of benzylpenicillin in experimental renal failure and Enterobacter cloacae meningitis.

The neurotoxic potential of benzylpenicillin administered as a continuous intravenous infusion was studied in rabbits with intact blood-CNS barriers, experimentally established Enterobacter cloacae meningitis and experimental renal failure, secondary to cephaloridine-induced acute tubular necrosis after iv administration. The concentrations of benzylpenicillin in serum, CSF and brain tissue fluid were assayed at the onset of epileptogenic electroencephalographic activity. The brain tissue concentrations of benzylpenicillin were consistently higher than those in CSF in both infected and uninfected animals.

Local anesthesia prevents hypertension following application of the Mayfield skull-pin head holder.

A marked hypertensive response is often seen when the Mayfield skull-pin device is applied to stabilize the head of the anesthetized patient for neurosurgery. In a prospective, blinded and randomized trial, 10 patients received an infiltration block of 0.5% mepivacaine with epinephrine 5 micrograms/ml (3 ml at each pin site) 1 min before the Mayfield holder was applied.

Microvascular decompression for trigeminal neuralgia.

An analysis of 57 patients with trigeminal neuralgia (TN) treated with microvascular decompression (MVD) is presented. Mean follow-up time was 3.1 years.