Frontolateral pins for halo ring placement: reassessment of a common neurosurgical procedure with CT measurements of skull thickness.

Object: Halo orthosis placement is a common neurosurgical procedure for the treatment of cervical spine injuries. Frontal sinus puncture by the anterior pins may occur using standard techniques, and up to 30% are dissatisfied with forehead scarring, especially women and African Americans.

Methods: The authors describe a frontolateral (FL) anterior pin site placement supported by high-resolution CT scan skull thickness measurements.

Chronic epilepsy due to low grade temporal lobe tumors and due to hippocampal sclerosis: do they differ in post-surgical outcome?

Chronic seizures as a presenting feature of low grade temporal lobe gliomas and hippocampal sclerosis (HS) are reported to have similar outcomes although the prognostic indicators may not be the same. This study seeks to identify the variables that are associated with poor surgical outcome in both conditions. A retrospective analysis from our epilepsy data base was performed.

Temporal lobe gangliogliomas associated with chronic epilepsy: long-term surgical outcomes.

Objective: To review the clinical features and surgical outcome in patients with temporal lobe gangliogliomas associated with intractable chronic epilepsy.

Methods: The Rush University Surgical Epilepsy Database was queried to identify patients with chronic intractable epilepsy who underwent resection of temporal lobe gangliogliomas at Rush University Medical Center. Medical records were reviewed for age of seizure onset, delay to referral for surgery, seizure frequency and characteristics, pre-operative MRI results, extent of resection, pathological diagnosis, complications, length of follow-up, and seizure improvement.

Repositioning of supraorbital nerve stimulation electrode using retrograde needle insertion: a technical note.

Introduction: With growing interest and acceptance of peripheral nerve stimulation (PNS) approach, there is now an increasing need in developing clear procedural details to resolve frequent complications and minimize associated tissue injury. Migration and suboptimal positioning of PNS electrodes are one of the most commonly observed complications of PNS approach.

Materials And Methods: We present a simple technique for repositioning a supraorbital electrode using retrograde insertion of introducer needle that allows one to place percutaneous (cylindrical) PNS electrode into appropriate anatomical location with minimal additional injury to surrounding tissues.

Evaluation of the prognostic indicators of giant intracranial aneurysms.

The indicators of poor outcome in giant intracranial aneurysms have been the subject of several studies in the literature. We conducted a retrospective analysis to evaluate the predictors of poor outcome in giant intracranial aneurysms. We studied consecutive cases with aneurysms admitted over a 9-year period in our institution.

Cerebral ischemia as a presenting feature of intracranial aneurysms: a negative prognostic indicator in the management of aneurysms.

Objective: Cerebral ischemia (stroke) can be a presenting clinical feature of intracranial aneurysms and may herald poor prognosis.

Methods: A retrospective review of admissions for aneurysms over a 6-year period revealed that 12 patients (5%) had stroke or stroke-like presentations among 236 patients with intracranial aneurysms. Patient demographics, characteristics of aneurysms, and management were analyzed.

Management of carotid artery injuries: Louisiana State University Shreveport experience.

Background: Traumatic carotid artery injury is an infrequently encountered surgical entity. Carotid artery injuries in polytrauma patients can be easily missed in the absence of clinical findings and/or presence of confounding concurrent injuries.

Methods: Between 1991 and 1998, 23 patients were diagnosed with various carotid artery injuries at the trauma center of Louisiana State University Health Sciences Center, Shreveport, Louisiana.

Selective intraoperative angiography in intracranial aneurysm surgery: intraoperative factors associated with aneurysmal remnants and vessel occlusions.

Background: The objective of this study was to assess the role of selective intraoperative angiography and to analyze the factors associated with faulty clip application.

Methods: Two hundred thirty-eight patients undergoing surgery for intracranial aneurysms were studied consecutively for intraoperative angiography (IOA)-related events. The procedure was performed in 155 operations.

Primary cerebral sarcoid granuloma: the importance of definitive diagnosis in the high-risk patient population.

Sarcoidosis of the central nervous system has been variously reported in 5-15% of all sarcoid patients. However, presentation of sarcoidosis as an isolated 'intracranial tumor' is rare. A 35-year-old African-American woman presented with intractable headaches.

Far-lateral approach to intradural lesions of the foramen magnum without resection of the occipital condyle.

Object: The goal of this study was to determine whether drilling out the occipital condyle facilitates surgery via the far-lateral approach by comparing data from 10 clinical cases with that from studies of eight cadaver heads.

Methods: During the last 6 years at Louisiana State University Health Sciences Center-Shreveport, 10 patients underwent surgery via the far-lateral approach to the foramen magnum. Six of these patients harbored anterior foramen magnum meningiomas, one patient a dermoid cyst, two patients vertebral artery (VA) aneurysms, and an additional patient suffered from rheumatoid disease of the craniocervical junction.