ABSTRACT
INTRODUCTION: Treatment or multilevel hydrocephalus is a complex problem. Neuroendoscopic interventions, make it possible to combine minimal invasiveness with the possibility of fenestration of several cysts during one procedure and thereby eliminate multi-level occlusion. We present our the experience of using a neodymium YAG laser (Nd-YAG laser) as an additional tool to improve the treatment results of patients with non-communicating hydrocephalus. MATERIAL AND METHODS: This study included 10 patients aged from 5 months to 8 years who underwent endoscopic interventions with the use of rigid endoscope with frameless navigation. A surgical laser with a radiation wavelength of 1.064 µm was used as the main tool for fenestrating the walls of the cysts. RESULTS: 13 endoscopic laser interventions were performed in 10 patients with multilevel hydrocephalus. In 3 children, the two-stage treatment was chosen in due to the impossibility of simultaneous fenestration of all cysts. The interval between procedures was 1 month in two cases and 11 months in one case. We managed to compensate for cerebrospinal fluid disturbances in each patient, positive dynamics in the condition was noted. The duration of postoperative stay averaged 8 days (from 4 to 13 days). There were no deaths in the study group. All patients were discharged in good condition. Average follow-up duration was 14 months (from 8 to 25 months). During the observation, the condition of the patients remained stable; there was no need for repeated operations. CONCLUSION: Combined use of bypass operations, endoscopic techniques and neural navigation may improve the results of treatment of patients with multilevel hydrocephalus. Data presented in this article demonstrates the safety and effectiveness of the clinical use of laser radiation as an additional tool for interventions in patients with this condition.
Subject(s)
Hydrocephalus/surgery , Lasers, Solid-State/therapeutic use , Neuroendoscopy , Child , Endoscopy , Humans , Infant , Reoperation , Treatment OutcomeABSTRACT
We report a successful endovascular treatment of complex arteriovenous malformation of the spinal cord at the cervical level. The strategy, technical aspects and the main principles of embolization of arteriovenous malformation are considered in the article.
Subject(s)
Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/therapy , Embolization, Therapeutic , Humans , Neck , Spinal CordABSTRACT
AIM: The study objective was to verify venous compression as a cause of trigeminal neuralgia (TN) and to define the optimal surgical tactics for TN patients. MATERIAL AND METHODS: Four hundred twenty one patients were operated on for TN at the Neurosurgical Department of the City Hospital â2 from 1998 to 2015. Veins in the trigeminal nerve root entry zone, as a significant compression factor, were identified in 40 patients (9.5%). Intraoperative data, questionnaires, and self-assessment inventories were analyzed. Treatment outcomes were assessed using the Barrow Neurological Institute (BNI) scale. RESULTS: Patients with venous compression were divided into two groups. Eleven (27.5%) patients in the first group had isolated venous compression. The feature of microvascular decompression (MVD) in these patients was identification of all veins, vein mobilization, and, if possible, vein coagulation and resection. Resection of the vein along its course is a basic procedure to avoid recurrent neuralgia. The second group included 29 (72.5%) patients with a combination of venous and arterial compression. In these patients, a vein acted as an "assisting" compression factor: the vein changed the course of a compressing artery or nerve and exerted an additional compression effect on the nerve. The surgical tactics involved exploration of the trigeminal nerve root entry zone, arterial loop mobilization, and placement of a Teflon protector; venous vessels were coagulated and resected. The MVD efficacy was as follows: in group 1, 10 patients had a BNI score I-III, and 1 patient had a BNI score IV; in group II, 25 patients had a BNI score I-III, and 4 patients had a BNI score IV. CONCLUSION: Venous compression can play both independent and assisting roles in the TN genesis. When exploring the trigeminal nerve, examination of the proximal trigeminal nerve is of particular importance, with paying attention to veins that may be a compression factor. In the case of isolated venous compression, the MVD surgical technique has some peculiarities, in particular coagulation and resection of veins compressing the trigeminal nerve root entry zone.
Subject(s)
Nerve Compression Syndromes/surgery , Pain/surgery , Trigeminal Neuralgia/surgery , Veins/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Microvascular Decompression Surgery , Middle Aged , Nerve Compression Syndromes/complications , Nerve Compression Syndromes/physiopathology , Pain/complications , Pain/physiopathology , Treatment Outcome , Trigeminal Neuralgia/etiology , Trigeminal Neuralgia/physiopathology , Veins/physiopathologyABSTRACT
UNLABELLED: The management of patients with facial nerve palsy is a challenge of modern neurosurgery. The study purpose was to evaluate the degree of facial nerve function recovery, following trigeminal neurotization. Trigeminal neurotization was performed in 23 patients within 1 to 10 months after the development of facial paralysis. In most cases, the cause of facial paralysis was surgery for space-occupying lesions of the cerebellopontine angle (95.6%). Outcomes of trigeminal neurotization were evaluated in 17 (73.9%) patients who were followed-up for more than 6 months. In 16 (94.1%) patients, the facial nerve function was recovered to a House-Brackmann grade III-IV. Given the surgery RESULTS: we can say that trigeminal neurotization is one of the effective treatments for facial paralysis. In most cases, this technique has provided good outcomes without additional complications, which is important for this group of patients.