ABSTRACT
The management of intracranial aneurysms has truly evolved after the introduction of the endovascular treatment. In this paper we compare patients that were operated or embolized for intracranial aneurysms. Between 1995 and 1999, 78 grade I to III ruptured aneurysms were treated in our service: 52 patients were operated, 21 were embolized and 5 were submitted to combinated endovascular and surgical treatment. In the surgical group, clinical outcome was very good in 80.8% of cases with 5% of mortality with 96.2% of total exclusion of the aneurysm. In the endovascular group, 95% of cases the clinical outcome was very good with only 42.8% of total exclusion of the aneurysm. By the endovascular method for treatment of aneurysms, we can obtain a good clinical outcome but a poor radiological outcome and sometimes need a complementary surgical procedure to treat residual aneurysm.
Subject(s)
Aneurysm, Ruptured/therapy , Embolization, Therapeutic/methods , Intracranial Aneurysm/therapy , Adult , Aged , Aneurysm, Ruptured/surgery , Female , Humans , Intracranial Aneurysm/surgery , Male , Middle Aged , Treatment OutcomeABSTRACT
INTRODUCTION: In our experience, frontolateral keyhole craniotomy in children is a safe approach for an experienced neurosurgeon to use in the treatment of the tumors or arachnoid cysts of the anterior fossa and sellar regions. TECHNICAL NOTE: The authors describe the frontolateral keyhole craniotomy, which is a modification of the generally used pterional approach. The operations were carried out through an approximately 2.5 x 3-cm frontolateral miniaturized craniotomy after a skin incision just above the eyebrow. We adopted this technique in pediatric neurosurgery.
Subject(s)
Cerebral Cortex/surgery , Craniotomy , Neurosurgical Procedures , Adolescent , Brain Neoplasms/surgery , Child , Child, Preschool , Dermatologic Surgical Procedures , Eyebrows , Humans , Infant , Tomography, X-Ray ComputedABSTRACT
TECHNIQUE: A novel technique of multilevel opening of the spinal canal is introduced into pediatric neurosurgery. Split laminotomy helps to preserve the spinal column integrity in cases of posterior exposure of the spinal canal. The spinal processes are cut in the midline and the laminae are separated and retracted while the lesion in the spinal canal is explored. At closure the lamina are simply sutured. RESULTS AND DISCUSSION: Excellent postoperative results were obtained in patients from different age groups. Pediatric peculiarities of the new method are discussed.
Subject(s)
Laminectomy/methods , Neurosurgery/methods , Pediatrics , Spinal Cord/surgery , Child , Child, Preschool , Humans , Imaging, Three-Dimensional/methods , Infant , Spinal Cord/pathology , Tomography, X-Ray/methodsABSTRACT
OBJECT: The authors analyze the factors that predispose to persistent hydrocephalus in children with posterior fossa tumors and compare their results and treatment policy with those described in the literature, particularly with regard to the higher postoperative shunt insertion rates, which have led some authors to the routine use of preoperative third ventriculostomy. METHODS: The clinical records of 180 children treated for posterior fossa tumors in the Department of Pediatric Neurosurgery of the National Institute of Neurosurgery, Budapest, Hungary, between 1990 and 2000 were retrospectively reviewed. CONCLUSIONS: The low postoperative shunt insertion rate in our series (15.5%) led us to believe that the routine use of preoperative third ventriculostomy is not entirely justified. Factors such as patient's age and tumor type, which showed a statistically significant association with the postoperative shunt requirement in our study, should be considered when the decision regarding treatment is made.
Subject(s)
Cerebrospinal Fluid Shunts/standards , Cranial Fossa, Posterior/surgery , Hydrocephalus/epidemiology , Hydrocephalus/surgery , Skull Base Neoplasms/epidemiology , Skull Base Neoplasms/surgery , Cerebrospinal Fluid Shunts/instrumentation , Child , Child, Preschool , Cranial Fossa, Posterior/diagnostic imaging , Cranial Fossa, Posterior/pathology , Humans , Hydrocephalus/diagnosis , Magnetic Resonance Imaging , Postoperative Care , Risk Factors , Skull Base Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
Realizamos análise comparativa dos resultados clínicos e radiológicos após o tratamento de aneurisma roto, localizado no setor anterior, por cirurgia ou por via endovascular. Entre 1995 e 1999, 78 pacientes foram tratados em nosso serviço por apresentarem ruptura de aneurisma intracraniano com grau clínico (Hunt & Hess) variando entre I e III. Dentre estes pacientes, 52 foram operados, 21 embolizados e 5 fizeram tratamento combinado. Dos casos cirúrgicos, o resultado clínico foi considerado ótimo em 80,8 por cento com mortalidade de 5 por cento e oclusäo completa do aneurisma em 96,2 por cento. Dos pacientes embolizados, 95 por cento dos casos o resultado foi considerado ótimo com oclusäo completa do aneurisma em 42,8 por cento. O tratamento endovascular de aneurismas intracranianos apresenta uma vantagem no resultado clínico em relaçäo aos aneurismas operados. Porém, apresentam taxa de exclusäo completa baixa e podem necessitar de tratamento complementar