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BACKGROUND: The knowledge of sinonasal vasculature is inevitable in transnasal neurosurgery. We performed an anatomical study on the sphenopalatine artery from the perspective of skull base procedures. METHODOLOGY: To analyse the anatomical landmarks of the sphenopalatine artery, arterial skull corrosion casts (26 head halves) underwent endoscopic transnasal phantom surgery. Furthermore, we performed microsurgical dissection on formaldehyde-fixated cadavers with arterial perfusion (14 head halves) as well as studied Cone Beam CT-scans of anonymised patients and cadavers (115 head sides). RESULTS: In our cadaveric material, the sphenopalatine foramen is located at the transition of the superior and middle nasal meatus (95.0%) or in the superior nasal meatus (5.0%). It is the main entry point of the branches of the sphenopalatine artery into the nasal cavity. In most cadaveric cases (25.0%), at this level there are 2 branches superiorly and 1 vessel inferiorly to the ethmoid crest. An average of 2.4 vessels leave the sphenopalatine foramen superiorly to the ethmoid crest, 97.8% of them belong to the sphenopalatine arterys posterior septal branches. An average of 2.1 branches leave the sphenopalatine foramen inferiorly to the ethmoid crest; all of them belong to the posterior lateral nasal branches. There are no cases with a single artery at the plane of the sphenopalatine foramen. We describe a triangular bony structure bordering the sphenopalatine foramen anteriorly which is built up by the palatine and ethmoid bone as well as the maxilla. According to the radiographic studies, this triangular prominence is surrounded superiorly by a posterior ethmoid cell (57.4%), the sphenoid sinus (41.7%) or the orbit (0.9%) with a varying contribution of the superior nasal meatus; inferolaterally by the maxillary sinus (98.3%) or the pterygopalatine and infratemporal fossa (1.7%) and inferomedially by the middle nasal meatus. The medial vertex of the bony triangle corresponds to the ethmoid crest of the palatine bone. In transnasal endoscopic surgery, the posterior lateral nasal branches of the sphenopalatine artery appear at the triangle's inferomedial edge, the posterior septal branches emerge at its superior edge. CONCLUSIONS: The triangular bony structure is a landmark to find and differentiate the posterior lateral nasal and posterior septal branches of the sphenopalatine artery and to identify the sphenoid sinus.
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Arterias/anatomía & histología , Procedimientos Neuroquirúrgicos , Paladar Duro/irrigación sanguínea , Hueso Esfenoides/irrigación sanguínea , Adulto , Anciano , Anciano de 80 o más Años , Puntos Anatómicos de Referencia , Cadáver , Tomografía Computarizada de Haz Cónico , Endoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cavidad Nasal/irrigación sanguínea , Cavidad Nasal/cirugíaRESUMEN
Conventional microscopic surgery of pituitary adenomas offers excellent results with regard to local tumour control and endocrine function. Overall patient morbidity and mortality is low. However, recent studies demonstrate further improvements in tumour resection control and more favourable endocrine/ophthalmologic results when endoscopic techniques are applied, as well as an overall reduction in peri-interventional morbidity. Additionally, use of endoscopic techniques in rhino-neurosurgical cooperation achieved better specifically rhinologic results and improved subjective comfort for patients. The cooperative rhino-neurosurgical approach not only allows for optimal treatment of the primary pituitary pathology, but also treatment of additional nasal and paranasal pathologies, such as a deviated septum or disturbed drainage of the paranasal sinus.
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Endoscopía/métodos , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/cirugía , Rinoplastia/métodos , Humanos , Resultado del TratamientoRESUMEN
The use of tracker dogs is the main method of finding hidden bodies, and in their search the dogs use typical scent patterns. "Electronic noses" can also be used to find and compare such patterns. Highly sensitive scent detectors have been successfully applied, e.g. in the examination of foodstuffs, in environmental tests and in material research. This study examined whether electronic sensors can be used to find bodies under outdoor conditions. The carcasses of two coneys were buried in soil at different depths. Over a period of 4 weeks, regular measurements were taken from the buried carcasses and from the control material. In addition, a "fingerprint" of the scent patterns was taken, and gas chromatography-mass spectrometry analyses were performed. Our findings indicate that it may be possible and viable to construct an "electronic body-tracking dog".
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Electrónica/instrumentación , Medicina Legal/instrumentación , Odorantes , Cambios Post Mortem , Animales , Entierro , Perros , Cromatografía de Gases y Espectrometría de Masas , Gases , Proyectos Piloto , ConejosRESUMEN
BACKGROUND: We present our experience using a standardized transnasal transclival approach (TTA) for endoscopic removal of chordomas of the clivus. PATIENTS: 13 patients with clival chordoma (CC) underwent tumor resection. Patients were operated by a surgical team consisting of a rhinosurgeon and a neurosurgeon. All patients underwent postoperative proton radiotherapy. Residual tumor was left in situations where radical removal would have entailed an increased risk of neurological deficits. RESULTS: Radical or near total removal of CC was accomplished in 12/13 patients. Intraoperative MRI (IMRI) was used in 4/13 CC patients. A watertight dural seal presented as the main challenge specifically for tumor extensions resulting in large dural defects. CONCLUSION: The TTA provides an elegant alternative to classical approaches to clival lesions especially for midline tumor locations. For large tumors iMRI is of significant help. Dural reconstruction of large defects emerged as the greatest challenge of this technique even for experienced endoscopic surgeons.
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Cordoma/cirugía , Fosa Craneal Posterior/cirugía , Cirugía Endoscópica por Orificios Naturales/métodos , Neoplasias de la Base del Cráneo/cirugía , Adulto , Anciano , Cordoma/patología , Cordoma/radioterapia , Fosa Craneal Posterior/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio , Neoplasias de la Base del Cráneo/patología , Neoplasias de la Base del Cráneo/radioterapiaRESUMEN
INTRODUCTION: Surgery in the temporomesial region is generally performed using a subtemporal, transtemporal, or pterional-transsylvian approach. However, these approaches may lead to approach-related trauma of the temporal lobe and frontotemporal operculum with subsequent postoperative neurological deficits. Iatrogenic traumatisation is especially significant if surgery is performed in the dominant hemisphere. METHODS: During a five-year period between January 2003 and December 2007, we have approached the temporomesial region in 21 cases via the supraorbital approach. In 15 cases, the lesion was located within the dominant hemisphere, all lesions had space-occupying effects. In all cases, meticulous approach planning was performed, demonstrating a close proximity of the lesion to the pial surface on the upper anterior mesial aspect of the temporal lobe. An extension within the parahippocampal gyrus or with deep temporobasal tumor growth below the sphenoid wing were considered as exclusion criteria for using the supraorbital approach. RESULTS: In all cases surgery was performed without intraoperative complications. Pathological investigation showed 7 low-grade astrocytomas, 4 high-grade astrocytomas, 2 gangliogliomas and 2 cavernomas. Early postoperative MRI scans confirmed a complete removal of the lesion in 14 cases. In one case of a subtotal resection, the residual tumor was removed through a posterior subtemporal approach. The postoperative neurological examination was unchanged in 14 cases. In one case a transient hemiparesis was observed. In patients with dominant-sided lesions no speech or mental deficits were present. CONCLUSION: In selected cases, the minimally invasive supraorbital craniotomy offers excellent surgical efficiency in the temporomesial region with no approach-related morbidity compared to a standard transtemporal or pterional-transsylvian approach.
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Neoplasias Encefálicas/cirugía , Craneotomía/métodos , Hueso Frontal/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Neuroquirúrgicos/métodos , Lóbulo Temporal/cirugía , Adulto , Astrocitoma/patología , Astrocitoma/cirugía , Neoplasias Encefálicas/patología , Dominancia Cerebral/fisiología , Femenino , Hueso Frontal/anatomía & histología , Lóbulo Frontal/anatomía & histología , Lóbulo Frontal/cirugía , Ganglioglioma/patología , Ganglioglioma/cirugía , Hemangioma Cavernoso del Sistema Nervioso Central/patología , Hemangioma Cavernoso del Sistema Nervioso Central/cirugía , Hipocampo/patología , Hipocampo/cirugía , Humanos , Masculino , Persona de Mediana Edad , Órbita/anatomía & histología , Órbita/cirugía , Giro Parahipocampal/patología , Giro Parahipocampal/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios , Lóbulo Temporal/patología , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Surgical management of multiple intracranial aneurysms may be difficult if located bilaterally. In the case of bilateral middle cerebral artery (MCA) aneurysms, surgical treatment through a unilateral approach is generally not recommended. In this study we describe the surgical technique and important factors that enable treatment of bilateral MCA aneurysms via a unilateral key-hole approach. PATIENTS AND METHODS: 15 patients (12 females, 3 males) with bilateral aneurysms of the MCA were surgically treated via a supraorbital key-hole approach. Age ranged from 37 to 60 years (mean: 47). 7 of the 15 patients presented with an acute subarachnoid hemorrhage (SAH). Cerebral angiography was performed in all patients pre- and postoperatively. Patients suffering from SAH were treated within the first 72 h. All 15 patients were planned to be operated via a unilateral supraorbital keyhole craniotomy using an eye-brow incision. RESULTS: In 10 of the 15 patients MCA aneurysms of both sides could be occluded completely through the unilateral approach. In 5 patients bilateral craniotomies had to be performed, in 1 of these patients during the same procedure. Factors necessitating a second craniotomy were brain swelling (1 patient with SAH), insufficient instruments (2 patients), and complex configuration of the contralateral aneurysm (2 patients). Permanent morbidity was anosmia in 1 patient and hyposmia and a mild visual field deficit in 1 further patient. CONCLUSION: Bilateral aneurysms of the MCA may be treated sufficiently through a unilateral supraorbital key-hole approach in selected patients. This is also possible in patients presenting with SAH. Factors necessitating bilateral craniotomies were brain swelling and complex configuration of the contralateral aneurysm.
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Craneotomía/métodos , Aneurisma Intracraneal/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Neuroquirúrgicos/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Cerebral Media/cirugía , Órbita/cirugía , Resultado del TratamientoAsunto(s)
Microcirugia/métodos , Neurocirugia/historia , Procedimientos Neuroquirúrgicos/métodos , Alemania , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Microcirugia/historia , Procedimientos Quirúrgicos Mínimamente Invasivos/historia , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Neuroquirúrgicos/historiaRESUMEN
Cavernomas are often small in size and located in difficultly accessible regions. Preoperative identification of the ideal surgical approach as well as the precise intraoperative implementation of the surgical plan are of critical importance for successful surgery. While aiming for minimally invasive surgical techniques and maximally effective cavernoma resection, we envisaged that employing a combination of precise and technically sophisticated virtual reality surgery planning, modern navigation systems with augmented reality features and endoscope-assisted surgical techniques should contribute to achieve this goal. Between December 2002 and November 2005, 66 patients were operated on for cerebral cavernomas in our department. In 23 cases surgery planning was done by using a virtual reality planning system, neuronavigation was used in 43 cases and the intraoperative augmented reality feature was used in 16 cases. 10 patients were operated by using the endoscopic assisted surgical technique. Complete resection was achieved in all cases. Using all nowadays available surgical tools, cerebral cavernomas can be operated with minimally invasive techniques and with excellent results.
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Neoplasias Encefálicas/cirugía , Hemangioma Cavernoso del Sistema Nervioso Central/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Neuroquirúrgicos/métodos , Adulto , Endoscopía/métodos , Humanos , Masculino , Neuronavegación/métodos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Neuronavigation is a commonly used technology that provides continuous, three-dimensional information for the precise localization of and surgical trajectory to brain lesions. This study was performed to evaluate the role that navigation can play in assisting microsurgical transsphenoidal surgery for precise localization and removal of recurrent pituitary tumours while simultaneously preserving pituitary gland function. METHOD: During a 6-month period -- July 2004 until December 2004 -- 9 patients with recurrent pituitary tumours (5 female and 4-male) were treated with navigation-guided transsphenoidal microsurgical resection. Surgery was performed via a paraseptal or endonasal transsphenoidal approach. The navigation system Vector Vision (Brain Lab, Heimstetten, Germany) allowed precise localization of the tumours (7 hormonal active and 2 inactive microadenomas) in respect to the pituitary gland, the carotid arteries and the cavernous sinus. RESULTS: Postoperative MRI investigations of the 9 patients treated with image-guided transsphenoidal microsurgery, showed total tumour removal in 7 (77 %) patients and subtotal removal in 2 patients (23 %). One patient (11 %) developed a cerebral spinal fluid (CSF) leak and was treated conservatively. One patient (11 %) had preoperative insufficiency of the corticotrope axis which remained unchanged postoperatively. Of the remaining 8 patients who did not have preoperative endocrinological disturbance, only one (12 %) developed postoperative insufficiency of the corticotrope axis. Out of the 7 patients with hormone active tumours, 5 (72 %) patients showed no more postoperative hormonal activity. CONCLUSION: Microneurosurgical transsphenoidal techniques combined with image-guided systems can precisely define the localization and removal of lesions in the sella region with respect to the margins of important anatomical structures in the neighbourhood and the endocrinological functionality of the pituitary gland.
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Adenoma/cirugía , Microcirugia , Recurrencia Local de Neoplasia/cirugía , Neuronavegación , Neoplasias Hipofisarias/cirugía , Adenoma/patología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Neoplasias Hipofisarias/patología , Estudios Retrospectivos , Silla Turca/patología , Resultado del TratamientoRESUMEN
Continuous improvement of surgical techniques is needed in skull base surgery in order to decrease intraoperative complications during various operations. However, the basis of minimizing damage in the operative field is a comprehensive knowledge of microsurgical anatomy. This article provides a detailed description of the cribriform plate and adjacent areas, based on investigations of over one thousand dried skulls and 225 computerized tomography scans of the anterior skull base. The main anatomic structures and the different types of the cribriform plate are demonstrated on color photographs and identified on CT scans as well. The variations important in anterior skull base approaches are also discussed and compared with the data found in the literature. The surface anatomy and development of the cribriform plate is described.
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Hueso Etmoides/anatomía & histología , Adulto , Anciano , Pesos y Medidas Corporales , Cefalometría , Niño , Preescolar , Fosa Craneal Anterior/anatomía & histología , Fosa Craneal Anterior/diagnóstico por imagen , Hueso Etmoides/diagnóstico por imagen , Senos Etmoidales/anatomía & histología , Senos Etmoidales/diagnóstico por imagen , Feto , Lóbulo Frontal/anatomía & histología , Lóbulo Frontal/diagnóstico por imagen , Humanos , Recién Nacido , Bulbo Olfatorio/anatomía & histología , Bulbo Olfatorio/diagnóstico por imagen , Órbita/anatomía & histología , Órbita/diagnóstico por imagen , RadiografíaRESUMEN
Cubital tunnel syndrome is the second most common entrapment neuropathy in the upper limb; however, surgical treatment of the ulnar nerve entrapment at the elbow remains controversial. None of the presently advocated procedures (simple decompression of the ulnar nerve, medial epicondylectomy, subcutaneous, submuscular or intramuscular anterior transposition of the ulnar nerve) has proven optimal regarding long-term results. This paper presents the experience of treating cubital tunnel syndrome with simple decompression in 40 patients. Three months after surgery 23/36 patients did not feel any pain in their operated hands. In 11/36 cases we observed an improvement of preoperative pain. Sensory disturbances disappeared completely in 24/40 cases. 11/40 patients reported an improvement of preoperative dysesthesia or hypesthesia. In 12/22 patients we observed complete recovery of preoperative pareses of adductor muscle of thumb or hypothenar muscles weakness. 7/22 cases demonstrated an improvement of these pareses. In total 28 patients (70 %) had an excellent outcome without residual symptoms. For 5 patients treatment results were classified as good with slight residual pain and sensory disturbance (12.5 %). In 4 cases (10 %) we only observed a fair outcome with persistent severe sensory and motor deficits but slow improvement over the last three months. Three patients did not demonstrate any improvement (7.5 %). The mean duration of postoperative disablement in our working patients (18/40) was 28 days. In summary, simple decompression of the ulnar nerve seems to be an adequate and successful minimally invasive technique for the treatment of cubital tunnel syndrome.
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Síndrome del Túnel Cubital/cirugía , Descompresión Quirúrgica/métodos , Nervio Cubital/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Síndrome del Túnel Cubital/complicaciones , Síndrome del Túnel Cubital/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Trastornos de la Sensación/etiología , Resultado del TratamientoRESUMEN
The endoscopic carpal tunnel release is a new minimally invasive method which has been used to decompress the median nerve in the carpal tunnel for the past decade. Advantages of this method should be a decreased postoperative morbidity and earlier return to work. Preoperative complaints, postoperative results and complications of the therapy for a total of 60 patients are presented. All endoscopic releases were performed using the Agee uniportal technique. The overall success rate in our study was 56/60 (93.3 %). 47/54 (87.0 %) patients were completely free of pain after endoscopic surgery. An improvement in preoperative pain was noted in 4/54 (7.4 %) patients. Hypesthesia and dysesthesia disappeared totally in 39/46 (84.8 %) patients. An improvement of the sensible disturbances was observed in 4/46 (8.7 %) cases. 10/13 (76.9 %) preoperative pareses recovered completely, 3/13 (23.1 %) remained unchanged. The complication rate in total in our series was 4/60 (6.7 %), thereof 3 cases of post-operative infection (5 %) and one serious median nerve injury (1.7 %). The mean time for return to work was 29 days. Summing up, it may be said that monoportal endoscopic carpal tunnel release appears to be an effective and safe minimally invasive method for the treatment of carpal tunnel syndrome.
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Síndrome del Túnel Carpiano/cirugía , Endoscopía/métodos , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/métodos , Adulto , Anciano , Anciano de 80 o más Años , Endoscopía/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: The natural history of brain stem cavernous malformations is unfavorable because of their high hemorrhage rate and resulting neurological deterioration among patients. However, direct surgery of intrinsic and anteriorly situated cavernomas is hazardous and leads to a bad postoperative outcome because of trauma to lateral and dorsally situated eloquent areas of the brain stem. METHODS: We review the cases of two patients with symptomatic cavernous malformations of the anterior brain stem and describe the usefulness of a transoral-transclival approach. A 23-year-old man developed progressive hemihypaesthesia and paraesthesia, hemiparesis with gait ataxia, dysarthria, dysphonia, and dysphagia. A 38-year-old woman suffered from an acute onset of vertigo with nausea and vomiting, diplopia, and paraesthesia of the left hand and foot. In both patients, computed tomography demonstrated the presence of brain stem hemorrhage, because of cavernous malformation. Magnetic resonance imaging showed a close proximity of the lesions to the pia mater only on the ventral surface of the brain stem. RESULTS: In both patients, the cavernomas could be safely approached and completely resected via a transoral transclival route. Three months after surgery, neurological examination revealed marked neurological improvement. The 23-year-old patient showed slight gait ataxia, no hemiparesis, no cranial nerve palsies; the 38-year-old woman demonstrated no neurological symptoms except for minimal motor dysfunction of the left hand. In both cases, under perioperative prophylactic antibiotics, no meningitis was observed. The patients could subsequently return to their previous employment. CONCLUSION: The transoral transclival approach for ventrally situated brain stem cavernomas allows a largely atraumatic resection of the lesion.
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Neoplasias Encefálicas/cirugía , Hemangioma Cavernoso/cirugía , Procedimientos Neuroquirúrgicos , Adulto , Neoplasias Encefálicas/diagnóstico , Tronco Encefálico/diagnóstico por imagen , Tronco Encefálico/patología , Tronco Encefálico/cirugía , Fosa Craneal Posterior/cirugía , Femenino , Hemangioma Cavernoso/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Boca/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Encéfalo/metabolismo , Aneurisma Intracraneal/complicaciones , Oxígeno/metabolismo , Papaverina/administración & dosificación , Hemorragia Subaracnoidea/tratamiento farmacológico , Vasodilatadores/administración & dosificación , Vasoespasmo Intracraneal/tratamiento farmacológico , Vasoespasmo Intracraneal/etiología , Humanos , Inyecciones Intraarteriales , Papaverina/uso terapéutico , Presión Parcial , Vasodilatadores/uso terapéuticoRESUMEN
Bovine pericardium has been widely used for grafts in cardiac surgery and seems to have suitable properties for use as a dural graft. We report on the use of solvent-preserved, gamma-sterilized Tutoplast bovine pericardium for dural grafts in 32 patients undergoing cranial and spinal operations with the objective of clinically assessing this material and technique by a retrospective analysis. All available records were reviewed and information regarding the indication for grafting, complications, and outcome were collected and analyzed for all patients. Indications for grafting included tethered cord myelolysis, closure of lumbosacral myeloceles, Chiari decompression, posterior fossa craniotomy, supratentorial craniotomy, and trauma. Outcomes were excellent in 31 patients; the one poor outcome was unrelated to surgical closure. The dural graft was not intended for outcome in any patient. Bovine pericardium was found to be a flexible and easily suturable, safe and cost-effective material for duraplasty. These results confirm the excellent suitability of Tutoplast bovine pericardium for dural substitution.
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Bioprótesis , Enfermedades del Sistema Nervioso Central/cirugía , Duramadre/cirugía , Pericardio/trasplante , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Bovinos , Enfermedades del Sistema Nervioso Central/economía , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Registros Médicos , Persona de Mediana Edad , Estudios Retrospectivos , Conservación de Tejido/economía , Resultado del TratamientoRESUMEN
Controversy surrounds the treatment of recurrent cubital tunnel syndrome after previous surgery. Irrespective of the surgical technique, namely pure decompression in the ulnar groove and the cubital tunnel distal of the medial epicondyle, and the different methods of volar transposition (subcutaneous, intramuscular, and submuscular), the results of surgical therapy of cubital tunnel syndrome are often not favorable, especially in cases of long-standing symptoms and severe deficits. Twenty-two patients who had previously undergone surgical treatment for ulnar nerve entrapment at the elbow were evaluated because of persistent or recurrent pain, paresthesia, numbness, and motor weakness. Ten patients had undergone a nerve transposition, 5 patients underwent a simple decompression of the ulnar nerve, and 7 patients experienced two previous operations with different surgical techniques. Two patients underwent surgery at our hospital, whereas 20 patients underwent their primary surgery at other institutions. Various surgical techniques were used during the subsequent surgery, such as external neurolysis, subcutaneous anterior transposition, and subsequent transfer of the nerve back into the sulcus. The causes of continued or recurrent symptoms after initial surgery included dense perineural fibrosis of the nerve after subcutaneous transposition, adhesions of the nerve to the medial epicondyle and retention of the medial intermuscular septum. The average follow-up after the last procedure was 7 months (2 - 20 months). All 7 patients with subsequent transfer of the ulnar nerve back into the sulcus became pain-free, whereas only 11 of 15 patients who had external neurolysis or subcutaneous transposition became free of pain or experienced reduced pain. The recovery of motor function and return of sensibility were variable and unpredictable. In summary, reoperation after primary surgery of cubital tunnel syndrome gave satisfactory results in 18 of 22 cases. Subsequent transfer of the ulnar nerve back into the sulcus promises to be useful in cases in which subcutaneous transposition had not been successful.
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Síndrome del Túnel Cubital/cirugía , Transferencia de Nervios/métodos , Nervio Cubital/cirugía , Adulto , Anciano , Síndrome del Túnel Cubital/tratamiento farmacológico , Síndrome del Túnel Cubital/patología , Femenino , Fibrosis , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Complicaciones Posoperatorias , Rango del Movimiento Articular , Recurrencia , Reoperación , Nervio Cubital/patologíaRESUMEN
The aim of this report is to present first experience in comparing the course of brain tissue oxygen pressure values (PtiO2) to changes in jugular vein oxygen saturation (SjvO2), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) after severe brain injury. PtiO2 monitoring was done using a polarographic Clark type microcatheter (LICOX pO2 probe) (GMS, Kiel, Germany) with a diameter of 0.5 mm and a sensitive area 7.9 mm long inserted in a right frontal position. The microcatheter was connected to a LICOX pO2 device. A fiber-optic catheter was used to measure SjvO2 and placed into the right internal jugular vein. The ICP monitoring was performed with a fiber-optic intraparenchymal device (Camino Laboratories, San Diego, Calif.) inserted in a left frontal position. Consistent correlations could be noticed between reduced PtiO2 and higher ICP and lower CPP levels. However, the absolute value of a single SjvO2 data point seemed to be less relevant diagnostically than its trend over a period of time. Owing to their experience, the authors suppose that PtiO2 monitoring will be a very important and reliable tool in the treatment of brain injury in the future, especially in its correlation to ICP and CPP.
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Presión Sanguínea , Lesiones Encefálicas/fisiopatología , Encéfalo/metabolismo , Circulación Cerebrovascular , Presión Intracraneal , Oxígeno/metabolismo , Adolescente , Adulto , Lesiones Encefálicas/diagnóstico por imagen , Humanos , Venas Yugulares , Persona de Mediana Edad , Monitoreo Fisiológico , Oxígeno/sangre , Presión Parcial , Tomografía Computarizada por Rayos XRESUMEN
In the present study, embryonic rat neocortex was implanted into the parietal subcortical area of adult naive animals. On the 7th day, the middle cerebral artery was permanently occluded ipsilateral to the graft. Twenty-four hours after middle cerebral artery occlusion, the extent of infarct was visualized by means of 2,3,5-triphenyltetrazolium chloride histochemistry and quantified in four different standardized coronal plains. Subsequently, the effects of fetal tissue grafting and those of transplantation were identified by using glial fibrillary acidic protein and nerve growth factor immunocytochemistry. The grafts integrated well into their new environment and significantly reduced the size of infarct in middle cerebral artery-occluded animals compared with both sham-operated and control rats 24 h postoperation. The underlying mechanism of this phenomenon might be an increased neurotrophic, particularly nerve growth factor, release by the grafted fetal tissue. Moreover, reactive astroglial cells may also trigger the neuroprotection by additional ischemia-induced nerve growth factor release. The present data demonstrate the potential neurotrophin-mediated protective effects of fetal brain tissue implanted into the adult rat brain before unilateral middle cerebral artery occlusion and the beneficial effects of astrocyte activation.
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Arteriopatías Oclusivas/cirugía , Encéfalo/cirugía , Arterias Cerebrales , Trasplante de Tejido Fetal , Factores de Crecimiento Nervioso/fisiología , Telencéfalo/embriología , Animales , Encéfalo/patología , Encéfalo/fisiopatología , Infarto Cerebral/patología , Masculino , Ratas , Ratas Long-Evans , Telencéfalo/fisiopatologíaRESUMEN
Seven fresh-frozen cadaver specimens had a calcaneal osteotomy performed obliquely through the posterior portion of the calcaneus. Angular relationships between the first metatarsal and talus were recorded with the use of a motion-analysis system in the transverse, sagittal, and coronal planes. The specimen was mounted in a testing machine and loaded via an intramedullary rod to 150, 350, and 550 N. A flatfoot model was created, and repeat measurements were obtained. The calcaneal osteotomy was then displaced 1 cm medially, and repeat measurements were made at each of the three load levels. The calcaneal osteotomy was then returned to its original position, the plantar fascia was divided, and the new angular measurements were obtained. The calcaneal osteotomy was again displaced 1 cm, and repeat angular measurements were obtained. A mild consistent flatfoot deformity was created in all three axes before the plantar fascia was cut. A statistically significant increase in deformity was noted after cutting the plantar fascia. A correction of the flatfoot deformity in all three planes occurred with the medial displacement of the calcaneal osteotomy, which was greater at the lower load levels. We noted that a medial displacement calcaneal osteotomy partially corrected a flatfoot deformity in all three planes. The correction occurred with or without an intact plantar fascia and, therefore, is independent of the structure. We also noted an increased deformity after dividing the plantar fascia. This study provides some biomechanical insight as to the corrective effect of a medial displacement calcaneal osteotomy in correcting a flatfoot deformity.
Asunto(s)
Calcáneo/cirugía , Fasciotomía , Pie Plano/cirugía , Modelos Biológicos , Osteotomía , Cadáver , Terapia Combinada , Femenino , Pie Plano/fisiopatología , Pie/fisiopatología , Humanos , MasculinoRESUMEN
Computed tomography (CT) images in combination with a navigation device enable three-dimensional (3-D) localization of intracranial lesions. Furthermore, CT scanning can be adapted for intraoperative application to actualize the image data and to check the anatomical situation during the operation. Frameless navigation was used in 100 patients. The procedure was performed in 46 cases with an optical navigation system, in 38 cases with a sensory arm, and in 16 cases with a navigated microscope. Six skin markers were used for registration. Mean fiducial registration error was 2.18 mm with a standard deviation of 1.03 mm. The indication for navigation was tumor localization and planning of the craniotomy in 81 cases, stereotactic biopsy in eight cases, and endoscopic procedures in 11 cases. Technical problems with the navigation system were observed in nine cases. In two additional cases the tumor was not found by navigation. All eight biopsy cases were successful, and histologically relevant specimens were obtained without complications. Navigation was helpful in 11 endoscopic cases for choosing an optimal trajectory through the foramen of Monro or for connecting multiple intraventricular cysts. For intraoperative CT imaging, the mobile Philips Tomoscan M was adapted to the needs of the operating environment. The mobile CT was used in 78 cases in the operating room: 16 patients who underwent a stereotactic procedure had only preoperative CT scans, 36 patients had an intraoperative CT during tumor surgery, and 26 patients during the test period of the device had only a postoperative CT investigation. In 10 cases (28%) of the intraoperative group the remaining tumor tissue could be demonstrated on the CT scans. The tumor remnants that were not visible in the microscopical surgical field were subsequently removed. According to our results, intraoperative navigation seems superior for the localization of intracranial lesions and intraoperative CT is more useful when considering the radicality of tumor removal.