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At least 235 records · Page 13Linked to original sources
PubMed2006

Anesthesia for functional neurosurgery: review of complications.

The use of functional stereotactic neurosurgery is increasing for treatment of patients with movement disorders and other chronic illnesses. The anesthetic considerations include the influence of the anesthetic agents on the microelectrode recordings and stimulation testing of an awake patient. The purpose of this study was to review the anesthetic management and incidences of intraoperative complications during functional neurosurgery in our institution. One hundred seventy-eight patients underwent an ablative procedure (n = 6) or the insertion of deep brain stimulator (n = 172) under monitored anesthesia care for movement disorders (n = 124), chronic pain (n = 20), and other procedures (n = 34). Local anesthetic was used for head frame pin sites and burr holes. No sedation/analgesia was administered to 57 (32%) patients. One patient required conscious sedation and another general anesthesia for the entire procedure. The remainder received small increments (mean +/- SD) of propofol (113 +/- 73 mg), midazolam (1.6 +/- 0.8 mg), and/or fentanyl (93 +/- 55 mug). Intraoperative complications that occurred in 16% of the patients included seizures (n = 8), change in neurologic status (n = 5), airway obstruction (n = 2), and hypertension (n = 7). Functional neurosurgery can be performed with minimal anesthesia in many patients. Awareness and vigilance can improve the identification and early treatment of intraoperative complications such as seizures, loss of airway, and changes in the neurologic status.

Adult↗
PubMed2005

Emergency neurosurgery by general surgeons at a remote major hospital.

BACKGROUND: Due to the geographical remoteness of Darwin, which has no resident neurosurgeon, emergency transfer of patients for neurosurgery is usually impractical. In Darwin emergency neurosurgery must be undertaken by general surgeons. METHODS: Data from the operating theatre, Emergency Department and Intensive Care Unit were prospectively recorded on all patients who underwent an emergency neurosurgical procedure between January 1992 and June 2004. Outcomes were assessed by retrospective case note review. RESULTS: Three hundred and five neurosurgical procedures were performed upon 258 patients (average 26.5 procedures per year), including 130 craniotomies, 88 burr holes, 3 posterior fossa craniotomies, 2 decompressive frontal lobectomies, 4 decompressive craniectomies, 25 elevations of fracture and 33 ventricular drains only. Assault/domestic incident (31%) was a more common aetiology than motor vehicle accidents (29%). Outcome was best for extradural haematoma (82% good/moderate) and chronic subdural haematoma (84% good/moderate). In contrast, 44% with acute subdural haematoma and 77% with intracerebral haematoma died. Irrespective of type of bleed, Glasgow Coma Scale (GCS) score at presentation was a reliable predictor of outcome following surgery (61% correlation): 60% with GCS less than 9 died whereas 79% with GCS over 11 had a good recovery. Acute Physiology And Chronic Health Evaluation, version 2 and Simplified Acute Physiology Score, version 2 scores were also independent predictors of outcome. Time from presentation to operation for extradural haematoma and acute subdural haematoma was prolonged (more than 4 h) in 48% and was associated with worse outcome (P = 0.0001). Neither extremes of age nor the particular surgeon performing the operation affected outcome. CONCLUSIONS: General surgeons undertake a substantial number of procedures across a broad spectrum of emergency neurosurgery in Darwin. Outcomes following surgery appear acceptable.

APACHE↗
PubMed2002

A community-centric internet portal for stereotactic and functional neurosurgery with a probabilistic functional atlas.

OBJECTIVE: This paper describes an Internet portal for stereotactic and functional neurosurgery with a probabilistic functional atlas (PFA) calculated from electrophysiological and neuroimaging data. This portal enables (1) data sharing among neurosurgeons; (2) the calculation of probabilistic functional maps of stereotactic target structures from a neurosurgeon's own data, optionally combined with data from other neurosurgeons, and (3) the construction and development of a PFA of the human brain by the neurosurgical community via the Internet. METHOD: The overall approach is done in three steps: (1) development and validation of the algorithm for PFA generation; (2) design and development of the portal for stereotactic and functional neurosurgery with tools for the rapid calculation, presentation, and use of the PFA, and (3) portal testing with the initial data acquired for 274 Parkinson's disease patients, 487 hemispheres, and 500 best contacts. This paper covers step 2 and some results from step 3. RESULTS: The Internet portal has been developed in Java and tested with the available data. Functions have been developed for: (1) data input, transfer, and editing; (2) data selection for PFA generation; (3) PFA generation; (4) PFA display and interactive manipulation, and (5) target planning. The portal has been put on the Internet for public use and so far more than 100 users downloaded it. CONCLUSION: The Internet portal for stereotactic and functional neurosurgery with a PFA potentially increases both the accuracy of targeting and the neurosurgeon's confidence. The portal may be useful for both experienced functional neurosurgeons who have studied numerous cases and novices in the field. The use of the PFA through this portal, and sharing and expanding its content by neurosurgeons represents a paradigm shift from manufacturer centric to community centric.

Anatomy, Artistic↗
PubMed1985

An applicability study on a CT-guided stereotactic technique for functional neurosurgery.

When a CT-guided stereotactic technique for functional neurosurgery is adopted, extremely precise targeting is needed to obtain satisfactory surgical results. In this study the authors have investigated the accuracy of the target points determined by CT-guided techniques and compared with those of conventional roentgenographically controlled stereotactic procedures. Stereotactic surgery, employing the Brown-Roberts-Wells (BRW) system, was performed contemporarily 26 times in 23 patients, that is, 9 times in 8 patients for functional neurosurgery using with the roentgenographic method, and 17 times in 15 patients with the CT-guided method only for intracranial neoplasm biopsy. As a result, there were no problems of accuracy of determining the target points by CT-guided stereotactic surgery with the BRW system. When applying this technique for functional neurosurgery, it should be pointed out that there could be a discrepancy within 2 mm from the conventional target determination.

Brain Diseases↗
PubMed2002

Blood use in cerebrovascular neurosurgery.

BACKGROUND AND PURPOSE: This study reviews the perioperative use of red blood cell transfusion in cerebrovascular neurosurgery. The current algorithm for preoperative ordering of red cells is historical and dated. More blood is ordered than is actually transfused, and considerable variability exists between different institutions. We determine the use of blood transfusion in cerebrovascular surgery to develop a rational blood ordering practice. METHODS: Records of 301 patients undergoing cerebrovascular neurosurgery at the University of Virginia were reviewed to quantitatively evaluate red blood cell transfusion practices. The amount and reason for transfusion were noted in each case. RESULTS: In 126 patients undergoing carotid endarterectomy, there were no preoperative or intraoperative transfusions and 5 postoperative transfusions (4.0%). In 71 ruptured aneurysm patients, there were 2 preoperative blood transfusions (2.8%), 4 intraoperative transfusions (5.6%), and 15 postoperative transfusions (21.1%). Forty-seven patients underwent surgery for unruptured aneurysms, with no preoperative transfusions, 2 intraoperative transfusions (4.3%), and 8 postoperative blood transfusions (17.0%). Of the 54 patients undergoing surgery for arteriovenous malformations, 5 patients (9.3%) were transfused preoperatively, 4 were transfused intraoperatively (7.4%), and 22 were transfused postoperatively (40.7%). None of the 3 patients undergoing surgery for concomitant arteriovenous malformations and aneurysms received intraoperative blood transfusions, but 1 received blood both preoperatively and postoperatively, and another received a transfusion postoperatively only. The overall ratio of perioperative cross-match to transfusion in this series is 41.4. CONCLUSIONS: In vascular neurosurgery at our institution, blood has routinely been ordered excessively. We recommend an ABO-Rh type and antibody screen for aneurysm and arteriovenous malformation surgery and no screen for carotid endarterectomy to efficiently utilize transfusion therapy in cerebrovascular surgery.

Blood Grouping and Crossmatching↗
PubMed2000

Negative outcome after neurosurgery for refractory obsessive-compulsive spectrum disorder.

OBJECTIVE: The authors sought to determine the long-term outcome of patients with severe and refractory obsessive-compulsive disorder spectrum (OCDS) following neurosurgery. METHOD: Five patients who underwent neurosurgery as a last-resort treatment for refractory OCDS were evaluated. On all patients, posttest data was obtained from the Yale-Brown Obsessive-Compulsive Scale, The Overvalued Ideas Scale, the Beck Depression Inventory and the Beck Anxiety Inventory. Pretest scores were available on three patients as well. RESULTS: All patients failed to maintain initial improvements after surgery and relapsed. In addition, they became depressed with suicidal ideation or attempt. CONCLUSION: Complications of neurosurgery are discussed, notably relapse and depression.

Adult↗
PubMed1999

Image-guided neurosurgery--state of the art and outlook.

The surgical possibilities of image guided neurosurgery are presented and critically reviewed. Image guided neurosurgery may enable neurosurgeons to work more precisely than before, and thus reduce mortality and morbidity. However, before the technology achieves widespread acceptance, technical standards must be developed, the intraoperative localisation technology improved, and clinical indications and the cost/benefit ratio clarified. Nevertheless, image guided neurosurgery appears to herald an exciting future in which virtual reality and robotic surgery will emerge as modern techniques.

Brain↗
PubMed1995

State of the Art and Future Directions of Minimally Invasive Stereotactic Neurosurgery.

The use of endoscopic techniques in neurosurgery has been limited to this point. Unlike gynecologic, urologic, and general surgery, the majority of neurosurgery is not performed in a large gas- or fluid-filled cavity. Endoscopic techniques, therefore, usually have been used for limited procedures within the ventricular system. A minimally invasive technique for intra-axial surgery, which is dependent on precise, three-dimensional navigation within the intracranial space, is provided by computer-assisted volumetric stereotaxis. Over 1000 tumor resection procedures employ volumetric stereotaxis, and these procedures not only have less morbidity than conventional procedures with similar pathology in the same locations, but also are cost-effective. Experience with these procedures has opened up many possibilities for future development of minimally invasive techniques in neurosurgery.

Journal Article↗
PubMed2000

[Sufentanyl in balanced anesthesia for neurosurgery. Comparative study with fentanyl] .

BACKGROUND: The aim of this study was to evaluate the effects of sufentanil in comparison with those of fentanyl during balanced anesthesia in patients undergoing neurosurgery. METHODS EXPERIMENTAL DESIGN: prospective randomized study. SETTING: operating room in a neurosurgery University department. PATIENTS: 50 patients, ASA I and II with age ranging from 18 to 77 years were divided in two groups randomly. INTERVENTIONS: 25 patients received sufentanil as single bolus dose of 0.2 microgram/kg i.v. as premedication and supplemental bolus doses of 0.15 microgram/kg during the maintenance of anesthesia while the remainders received fentanyl 2.0 micrograms/kg as premedication and supplemental boluses of 1.5 micrograms/kg. All patients were induced with propofol 2.5 mg/kg, were intubated after cisatracurium 0.15 mg/kg for muscle relaxation, then were ventilated with sevoflurane and O2:N2O (1:1). MEASUREMENTS: heart rate, SAP, DAP and MAP were recorded at different times and ECG, ETCO2 and pulsoximetry were monitored continuously. Furthermore postoperative analgesia by VAS, recovery time and inspiratory concentrations of the volatile anesthetic were evaluated. Statistical analysis was carried out using ANOVA for repeated measures and Bonferroni "t"-test; a value of p < 0.05 was considered to be significant. RESULTS: Significant changes in MAP (at IOT and 1 and 2 min after IOT), in HR (at IOT) and in RPP (at IOT and 1, 2 and 3 min after IOT) were recorded in group F. Recovery time was shorter in group S than in group F and postoperative analgesia was more prolonged in group S. Inspiratory concentrations of volatile agent were lower in patients treated with sufentanil than in those treated with fentanyl. CONCLUSIONS: In patients treated with sufentanil a better cardiocirculatory stability was achieved with lower inspiratory concentrations of volatile agent and a well relaxed brain. Sufentanil can be considered a valid alternative to fentanyl as analgesic agent in balanced anesthesia for neurosurgery.

Adolescent↗
PubMed2000

[Recent progress in intravascular neurosurgery for the treatment of cerebrovascular disease].

With the recent advances in the devices and techniques in intravascular neurosurgery such as microcatheters or a digital subtraction angiography, intravascular neurosurgery plays an important role for the treatment of cerebrovascular disease. We describe here, a recent progress in intravascular neurosurgery for the treatment of cerebrovascular disease. As a treatment of cerebrovascular disease, we discuss the treatment of cerebral aneurysm using Guglielmi detachable coils (GDC), and the treatment of ischemic cerebrovascular disease such as the thrombolytic therapy for the acute embolic occlusion of the cerebral artery, and a percutaneous transluminal angioplasty (PTA) or a stenting for the stenotic lesion of the cerebral arteries. Embolization of the cerebral aneurysm using GDC is less invasive method compare to the standard neurosurgical clipping of aneurysm. So, recently it becomes one of standard methods of the treatment of cerebral aneurysm. Thrombolytic therapy, PTA and stenting also become an important treatment for the ischemic cerebrovascular disease.

Angiography, Digital Subtraction↗
PubMed2002

[Conservative neurosurgery].

"Conservative neurosurgery" is an evident concept. Preservation of brain is by all means the goal of neurosurgical operations because there are no possibilities of compensation in case of lesion of brain parenchyma, either complete or partial. However, there is a great variability of functionnally eloquent areas in the brain; so a lesion may induce or not visible neurological deficits as function of the location of the lesion. The goal of this review article is to scan means used in neurosurgery to spare parenchymal brain, which is often called "minimal invasive neurosurgery" with a special interest of recent and current progress of morphological and functional imaging of the brain.

Brain↗
PubMed2006

[Ultrasound-guided minimally invasive neurosurgery in treatment of cranial tumors: clinical study].

OBJECTIVE: To explore the applicability of ultrasound-guided minimally invasive neurosurgery in treatment of intracranial tumors. METHODS: Thirty five patients with intracranial tumors diagnosed with preoperative CT and MRI underwent craniotomy. Intraoperative real-time monitoring ultrasound was conducted to detect the location, size and depth of the cerebral masses so as to determine the appropriate approach. At the end of operation, ultrasonography was used to explore the range of residue tumors. RESULTS: All the 35 patients acquired exact location of the tumors with ultrasound manifesting different levels of echo. According to the pathological results, the lesions of 32 patients (91%) were totally removed and 3 patients (9%) underwent subtotal resection. No infection was found. CONCLUSION: Ultrasound-guided minimally invasive neurosurgery is an effective real-time tool to localize brain tumors. It will provide a significant guidance for minimally invasive neurosurgery.

Adult↗
PubMed1986

Stereotactic neurosurgery: new aspects of an old method.

Seventy-seven patients underwent 93 stereotactic operations during a five-year period 1980-1984 at the Department of Neurosurgery, Oulu University Central Hospital, Oulu, Finland. Thirty patients were cases of general neurosurgery, consisting of 27 stereotactic biopsies of deep-seated brain tumors with a diagnostic accuracy of 89% (24/27), and three evacuation-aspiration procedures. Two-thirds of the operations (63/93) belonged to the field of functional neurosurgery, the most frequent procedure being stereotactic ventrolateral thalamotomy. In the treatment of drug resistant Parkinsonian tremor and rigidity the success rate was 70% in bilateral and over 90% in unilateral procedures. Operative mortality was 1.1% (1/93 operations) and morbidity 3.2%. Stereotactic technique is mandatory for diagnostic biopsies of deep-seated cerebral lesions. Its combination with computerized tomography ensures better resolution of the lesions and enables more radical therapeutic procedures to be undertaken. Furthermore, stereotactic operations are still indicated in selected cases of medically refractory disorders, especially in epilepsy and involuntary movement disorders.

Adolescent↗
PubMed1995

Development of an MRI-compatible needle insertion manipulator for stereotactic neurosurgery.

A variety of medical robots for stereotactic neurosurgery has been developed in recent years. Almost of all these robots use computed tomography (CT) to scan the brain of the patient before and during surgery. Currently, we are developing a needle insertion manipulator for magnetic resonance imaging (MRI)-guided neurosurgery. MRI techniques, including MRI angiography and functional MRI, are attractive for the development of interventional MRI therapies and operations. If a robot were available, these therapies would be minimally invasive, with more accurate guidance than is possible with current CT-guided systems. Actuation of a robot in an MRI environment is difficult because of the presence of strong magnetic fields. Therefore, the robot must be constructed of nonmagnetic materials. The system frame was manufactured using polyethylene terephthalate (PET) and was actuated using ultrasonic motors. Accuracy-evaluation procedures and phantom tests have been performed. The total accuracy of the system was approximately 3.0 mm. No artifacts caused by the manipulator were observed in the images.

Brain↗
PubMed1983

Lasers in neurosurgery: a review.

In recent years neurosurgeons have shown an increasing interest in lasers. An understanding of the basic laser mechanism and tissue effects is important. CO2 laser is an excellent no-touch tool for excising and evaporating brain tumors. It has several other uses in neurosurgery both with free-hand technique and with microscope attachment and a micromanipulator. It is easier and more precise to manipulate a laser beam than any of the conventional instruments. Nd:YAG and argon lasers are more effective for coagulation of blood vessels and for dealing with vascular neoplasms. Microvascular anastamosis has been achieved with the use of Nd:YAG laser in experimental animals and has potential for practical application in extra-intracranial bypass operations. There are many advantages and some disadvantages to the use of lasers in neurosurgery.

Argon↗
PubMed1994

Lasers in neurosurgery.

Lasers have been used in neurosurgery for the past 25 years, undergoing modifications to suit the specific needs of this medical discipline. The present report reviews the current use of lasers in neurosurgical practice and examines the pros and cons of lasers in specific neurosurgical applications. In spite of their advantages, laser use is still not widespread in neurosurgery. One reason is the continued lack of complete control over real-time laser interactions with neural tissue. A greater acceptance and use of lasers by neurosurgeons will depend upon automated control over defined specific parameters for laser applications based upon the type of tissue, the desired effect on tissue, and application to the clinical situation without loss of precision and a lot of expense. This will require the integration of newer lasers, computers, robotics, stereotaxy, and concepts of minimally invasive surgery into the routine management of neurosurgical problems.

Brain↗
PubMed1994

Endoscopic techniques in neurosurgery.

Endoscopic techniques have been utilized in neurosurgery for nearly a century. The history of application of these techniques is reviewed. Because of recent improvements in optics, microinstrumentation, and other associated technologies endoscopy has begun to have an impact on neurosurgery. Documented uses of these techniques are reviewed. Greater experience with the techniques, along with continued improvements in the technology, has the potential to result in broadened applications. These procedures can be performed quickly, safely, and effectively, and in selected applications may reduce tissue trauma, risks associated with surgery, hospital stays, and costs. Neuroendoscopy presents exciting possibilities for the future.

Brain↗
PubMed2002

Anatomy based research in neurosurgery.

The Anatomy Based Research in Neurosurgery is an important part of Applied Neuroanatomy that mainly concerns neurosurgical procedures and related problems, namely neuroimaging, brain mapping and surgical techniques. This includes a wide variety of research fields such as 2-D and 3-D structure visualization and referencing (stereotaxy), intraoperative imaging cartography and targeting (neuronavigation), as well as microsurgical, functional and endoscopic anatomy. The methods involved in this investigation regard predominantly microsurgical proceedings and morphological variability studies, both on living or post-mortem material (the strict neuroimaging techniques remaining a main tool for radiologists). The present paper provides an overview of the main techniques of neuroanatomical research applied to neurosurgery. Their major indications and requirements are described and discussed. Special attention is paid to some anatomical techniques such as microdissection and serial sectioning as well as 2-D and 3-D image procedures that are explained in detail.

Brain↗