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1.
Neuromodulation ; 24(8): 1347-1350, 2021 Dec.
Article in English | MEDLINE | ID: mdl-32074387

ABSTRACT

OBJECTIVES: Different anesthesia techniques are used for surgical implantation of paddle lead electrodes for neurostimulation through a laminectomy. We wanted to evaluate the use of dexmedetomidine as sedative for this procedure in a series of patients. Second, we wanted to verify whether the stimulation pattern and position of the electrode had to be changed during the procedure guided by the patient's feedback. MATERIAL AND METHODS: Twenty-five consecutive patients received surgical implantation of a spinal cord stimulation electrode under conscious sedation using dexmedetomidine and local anesthesia. We evaluated the effects of the administered drug, the patient comfort, and the adequacy of the stimulation pattern. RESULTS: Twenty-four patients completed the procedure with only dexmedetomidine and local anesthetic. Infusion was started on average 55 minutes (sd 29) prior to incision. The mean dose of lidocaine was 430 mg (sd 95). There were no significant hemodynamic changes. Median time to reach Modified Aldrete's score postoperative was 67 minutes (sd 38). In 46% of the patients, the position of the electrode was changed guided by the feedback of the patient. More than half of the patients remember most details of the procedure. Only four patients mentioned substantial discomfort and only three would definitely not want to undergo this procedure again. CONCLUSIONS: Implantation of spinal cord stimulation electrodes through a surgical laminectomy using dexmedetomidine is a safe and feasible procedure with adequate comfort for patient and surgeon. This way of working increases the optimal position of the electrode resulting in the most convenient stimulation pattern and avoiding revisions.


Subject(s)
Dexmedetomidine , Spinal Cord Stimulation , Conscious Sedation , Electrodes, Implanted , Humans , Laminectomy , Spinal Cord/surgery
2.
J Neurosurg Pediatr ; 9(2): 169-77, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22295923

ABSTRACT

Hydrocephalus is a clinical disorder resulting from an imbalance between the production of CSF and its resorption, of which the latter is mostly a disadvantage. In rare cases of choroid plexus papilloma or carcinoma, hydrocephalus is due to an overproduction of CSF. Choroid plexus hyperplasia (CPH) is a distinct clinicopathological entity in which the enlarged choroid plexus produces large amounts of CSF. Historically, patients with CPH were treated by shunt procedures or by microsurgical removal of the choroid plexus, which is associated with a high complication rate. In this paper the authors show that endoscopic plexus coagulation can result in restoring the equilibrium of the intracranial fluid volumes, resulting in shunt independency. In this way, both the shunt-related complications and the bleeding risks of microsurgical plexectomy are avoided. In instances of hydrocephalus, thorough efforts should be made to demonstrate the underlying pathophysiology to choose the optimal treatment, of which shunt procedures should receive the least priority.


Subject(s)
Choroid Plexus/pathology , Choroid Plexus/surgery , Endoscopy/methods , Hyperplasia/surgery , Central Nervous System Fungal Infections/complications , Central Nervous System Fungal Infections/surgery , Cerebral Ventricles/pathology , Cerebrospinal Fluid Shunts , Child, Preschool , Drainage , Electrocoagulation , Female , Humans , Hydrocephalus/complications , Hydrocephalus/surgery , Hyperplasia/cerebrospinal fluid , Hyponatremia/etiology , Magnetic Resonance Imaging , Recovery of Function , Reoperation , Supine Position , Treatment Outcome
3.
J Neurol Neurosurg Psychiatry ; 81(6): 685-9, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20176602

ABSTRACT

Intracranial dural arteriovenous fistulas constitute a rare though potentially devastating disease. Because the arterial (high-pressure) blood flow drains directly into the low-pressure venous system, there is a high risk of bleeding and associated neurological deficit. The classifications by Borden and Cognard underline the correlation between bleeding risk and venous drainage pattern of the fistula. There are different treatment options for this vascular pathology, which always poses a challenge for the physicians involved to offer the optimal treatment for an individual patient. This case report illustrates how combining forces between the neurosurgical and endovascular team benefits outcome. Simultaneously, this contributes to the growing amount of evidence that a new endovascular technique with transarterial ONYX embolisation enables complete obliteration of the vascular malformation.


Subject(s)
Central Nervous System Vascular Malformations/surgery , Endoscopy/methods , Neurosurgical Procedures/methods , Vascular Surgical Procedures/methods , Humans , Male , Middle Aged , Treatment Outcome
4.
Surg Neurol ; 71(5): 610-2; discussion 612, 2009 May.
Article in English | MEDLINE | ID: mdl-18291481

ABSTRACT

BACKGROUND: We report on a patient in whom a subfascially implanted pump for the intrathecal delivery of baclofen spontaneously migrated into the peritoneal cavity. CASE DESCRIPTION: A 54-year-old male patient presented with a refilling problem of a drug pump that had been implanted 16 months earlier subfascially through a right-sided incision 10 cm below the costal margin. Because we were unable to refill the pump even under fluoroscopy, we presumed a backward turning of the pump. At exploration, we found that the deeper part of the pocket had spontaneously eroded and had caused the migration of the pump into the peritoneal cavity. The peritoneum and the abdominal wall were closed and the pump was placed in a subcutaneous pouch. We suppose that the migration of the pump was due to its particular implantation site with the lower extent of the device at or below the level of the linea semilunaris. Below this line, the aponeuroses of all 3 lateral abdominal muscles pass in front of the rectus muscle, leaving only the transversal fascia underneath the rectus, which is not a solid layer. Not considering this anatomical detail may facilitate the inward migration of implanted material. CONCLUSION: When creating a pocket for subfascial implantation, a high subcostal incision should be used so that the lower extent of the pocket will still be above the level of the linea semilunaris, hence ensuring a strong fascial layer between the pump and the peritoneum.


Subject(s)
Abdominal Muscles/pathology , Abdominal Wall/pathology , Abdominal Wall/surgery , Foreign-Body Migration/pathology , Infusion Pumps, Implantable/adverse effects , Peritoneal Cavity/pathology , Abdominal Muscles/anatomy & histology , Abdominal Wall/anatomy & histology , Accidents, Traffic , Baclofen/administration & dosage , Foreign-Body Migration/etiology , Foreign-Body Migration/physiopathology , Humans , Injections, Spinal/adverse effects , Injections, Spinal/instrumentation , Injections, Spinal/methods , Male , Middle Aged , Muscle Relaxants, Central/administration & dosage , Peritoneal Cavity/surgery , Postoperative Complications/etiology , Postoperative Complications/pathology , Postoperative Complications/surgery , Quadriplegia/drug therapy , Quadriplegia/etiology , Reoperation , Spinal Cord Injuries/etiology , Spinal Cord Injuries/physiopathology , Subcutaneous Tissue/anatomy & histology , Subcutaneous Tissue/pathology , Subcutaneous Tissue/surgery , Treatment Outcome
5.
Surg Neurol ; 69(5): 535-7, 2008 May.
Article in English | MEDLINE | ID: mdl-18262243

ABSTRACT

BACKGROUND: Thoracic meningoceles are associated with neurofibromatosis 1 in 60% to 85% of all cases. Usually, these meningoceles remain asymptomatic, but back pain, headache, cough, and dyspnea are possible manifestations. Often, there is an associated kyphoscoliotic deformity of the thoracic spine. CASE DESCRIPTION: A 60-year-old woman known in our department after a fossa posterior decompression for an Arnold-Chiari malformation was admitted through the emergency department because of progressive dyspnea. A giant intrathoracic meningocele was already diagnosed earlier but was left untreated because the patient was asymptomatic at that time. She now had dyspnea, and on chest x-ray and CT scan, there was an obvious shift of the mediastinum to the right. Because of the long-existing hemithoracic meningocele, we assumed that this patient actually had only 1 functional lung, and so, left-sided thoracotomy with resection of the meningocele and closure of the defect included a high operative mortality. Instead, we chose to obtain a permanent drainage of the meningocele by putting a shunt between the meningocele and the peritoneum. Postoperatively, the patient recovered well and became oxygen-independent. CONCLUSION: Treatment of giant intrathoracic meningoceles in patients with progressive dyspnea can be challenging, and different options can be found in the literature. Treatment with a cystoperýtoneal shunt, as in our case, can be a less invasive alternative in patients with a high operative mortality risk. To our knowledge, this is the first report of a patient with neurofibromatosis 1 treated in this way.


Subject(s)
Drainage/methods , Meningocele/surgery , Neurofibromatoses/complications , Catheterization , Female , Humans , Meningocele/complications , Meningocele/pathology , Middle Aged , Neurofibromatoses/pathology , Neurofibromatoses/surgery , Peritoneum , Thoracic Vertebrae
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