Background
Surgery is superior over medicamentous treatment of pharmacoresistant mesial temporal lobe epilepsy caused by hippocampal sclerosis. The armamentarium of surgical procedures comprises ...standard temporal lobectomy and more selective procedures. Selective amygdalohippocampectomy can be performed via transcortical, transsylvian or subtemporal approach.
Method
Describe the selective amygdalohippocampectomy through the subtemporal approach
Conclusion
After the detailed preoperative epilepsy evaluation, surgery can be offered to pharmacoresistant epilepsy patient with hippocampal sclerosis. Selective amygdalohippocampectomy can be safely performed through the subtemporal approach. The good knowledge of the mesial temporal lobe anatomy is necessary when performing this procedure.
Key points
• Perform the subtemporal craniotomy with additional bone removal up to temporal petrous part to minimize retraction of the brain.
• Release the CSF from the subarachnoid sulcal space in order to relax the temporal lobe. Dissect the arachnoid around basal temporal veins and protect them with hemostatic material in order to avoid vein rupture.
• After gyrus fusiformis corticotomy, always follow the white matter in order to enter the temporal horn.
• Place the self-retraining retractor gently to secure an unobstructed view of the intraventricular mesial temporal lobe structures.
• Visualize the choroid plexus and the inferior choroidal point. They represent the two most important landmarks.
• While performing the anterior disconnection the goal is to reach the arachnoid of the interpeduncular and crural cistern medially and the tentorial edge laterally.
• Follow the tentorial edge and the arachnoid of the temporal base to securely perform the lateral disconnection.
• Perform the posterior disconnection at the level of the mesencephalon superior colliculi.
• During the medial disconnection the dissection of the arachnoid of the hippocampal sulcus must be done as close to the hippocampus as possible in order to avoid damage to the brain stem perforators or the loop of the anterior choroidal artery.
• Knowledge of mesial temporal lobe anatomy is crucial.
Empty Sella in the Making Kirigin Biloš, Lora Stanka; Kruljac, Ivan; Radošević, Jelena Marinković ...
World neurosurgery,
August 2019, 2019-Aug, 2019-08-00, 20190801, Letnik:
128
Journal Article
Recenzirano
Pituitary apoplexy may occur when a large tumor compresses or outgrows its nutrient supply, resulting in ischemic necrosis and hemorrhage. Although once deemed a neurosurgical emergency, increasing ...evidence suggests that conservative management of pituitary apoplexy leads to favorable neuro-ophthalmologic and endocrinologic outcomes as well. Spontaneous remission after pituitary apoplexy has been described in functioning pituitary adenomas, but it is a rare occurrence in nonfunctioning tumors.
We report a man that presented with pituitary apoplexy of a nonfunctioning pituitary macroadenoma that was managed conservatively and treated hormonally for hypopituitarism during a 2-year follow-up period, with serial neuroimaging demonstrating significant tumor volume reduction with almost complete resolution resulting in partial empty sella. In addition, a short literature review was performed pertaining to the management of pituitary apoplexy with emphasis on a more conservative approach.
A subset of patients with pituitary apoplexy without altered consciousness and nonprogressive or mild ophthalmologic deficits may be managed conservatively; however, lifelong periodic assessment, preferably by a specialized multidisciplinary pituitary team, is essential until clinical outcomes become clear.
In the treatment of degenerative lumbar stenosis, facet-sparing laminectomy with instrumented fusion (FSL) was recently almost totally replaced by less invasive, allegedly equally effective surgical ...techniques. We performed a long-term comparison between outcomes after Young laminoplasty (YL) as a representative of the less invasive technique and FSL.
From December 4, 2000, to March 11, 2005, 56 patients with a history of neurogenic claudication and radiologically verified absolute lumbar stenosis were surgically treated. After applying inclusion and exclusion criteria, 44 patients were enrolled.
Using the Oswestry Disability Index scale, significant improvement on 1-year and 8-year follow-up examinations was noticed in the FSL and YL groups. The Oswestry Disability Index was significantly better in the FSL group compared with the YL group at the 8-year follow-up (27.82 ± 1.918 vs. 40.74 ± 2.163).
FSL is a more invasive and more expensive surgical technique than YL. In a short-term and long-term follow-up comparison, FSL is a more successful operative technique, and the difference increases over time in favor of FSL.
Cavernous malformations are classified as a group of vascular malformations of the central nervous system. Conservative treatment of brainstem cavernomas is accompanied with poor outcome. Surgery ...ofbrainstem cavernomas still poses a challenge due to the high risk of neurological damage and respectable morbidity. We report a case of complete neurological recovery in a 24-year-old female patient with mesencephalic cavernoma treated surgically. This case highlights that careful microsurgical treatment with the goal of complete cavernoma excision remains the treatment of choice in cases with de novo or recurrent hemorrhage. Intraoperative neurophysiologic monitoring should be used as the gold standard during brainstem cavernoma operations in order to avoid nuclear and long tract damages.
Cervical spondylosis is common condition rarely associated with radiculomyelopathy which surgical treatment, according to meta-analysis, is not better than nonsurgical. Our hypothesis was that ...neurodecompression which type is chosen according to spinal alignment should result in better functional improvement comparing with nonsurgical treatment. Between January 1, 1998 and December 31, 2007 a total of 77 patients with spondylogenic myelopathy were selected for the study. The inclusion criteria were symptoms and signs of myelopathy Ranawat grade III. Exclusion criteria were amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS). The curvature of the cervical spine was determined by Ishihara index. Anterior corpectomies and fusion was performed in the kyphotic spines, laminectomy with fusion in patients with neutral position, and open door laminoplasty in lordotic spines. Clinical improvement was assessed as differences between preoperative and 1-year follow up Nurick, modified Japanese Orthopedic Association (mJOA) myelopathy scales and walking test. Preoperative and postoperative transverse cord area and subarachnoid space were measured. Forty-four male and 31 female patients were surgically treated. Two patients with electrophysiological signs of ALS were excluded. Preoperative and postoperative mean +/- SD mJOA index was 9.15 +/- 1 and 13.01 +/- 1.4 (p < 0.001), Nurick grading scale 3.05 +/- 0.7 and 1.8 +/- 0.6 (p < 0.001), walking time (sec) 64.4 +/- 3.2 and 46.2 +/- 3.3 (p < 0.001), and number of steps 69.7 +/- 4.4 and 57.6 +/- 2.8 (p < 0.001) respectively. Preoperative and postoperative transverse cord area (mean +/- SD, mm2) was 46.7 +/- 5.4 and 60.2 +/- 2.6 (p < 0.001), and subarachnoid space 48.0 +/- 4.9 and 68.8 +/- 8.5 (p < 0.001) respectively. Our results showed that surgical treatment is beneficial for patients with spondylogenic myelopathy.
Vratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. ...Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralježnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Prvi dio se odnosi na dijagnostiku, a drugi, njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke procedure. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.
Highlights Long-term comparison between outcomes of laminoplasty and laminectomy with fusion. We measured difference in the ODI score at 1-year and 8-year follow-up examinations. Laminectomy with ...fusion is in a 1-year follow up more successful operative technique. At 8 year follow-up that difference increases in favor of laminectomy with fusion.
Vratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. ...Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralješnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Ovaj prvi dio odnosi se na dijagnostiku, a drugi njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke postupke. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.
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