Introduction:The spinal cord stimulation (SCS) has been described as a valuable neuromodulating procedure in the management of chronic and medically untreated neuropathic pain. Although many studies have discussed the use of this technique, a question still remains regarding its efficacy in different medical conditions with different etiology in the long term. The aim of this paper is to discuss the risks, complications, cost-effectiveness, and results of SCS in patients affected by chronic neuropathic pain based on the comprehensive literature review.
Pericallosal artery aneurysms should have a better prognosis than the aneurysms located in the other parts of the circle of Willis. Complications are related to the patients" age. If possible, these aneurysms should always be clipped due to potential risk of bleeding and difficulty of embolization.
BACKGROUND:Tuberculum sellae meningiomas is a serious challenge for neurosurgeons. It accounts for up to 10% of all intracranial meningiomas. The difficulty in surgically excising a Tuberculum sellae meningioma comes from its anatomical relationship to the optic nerves and chiasm and to the anterior cerebral and internal carotid arteries and their perforators. The authors discuss the main approaches and the complications based on their experience in comparison to previously reported data. METHODS: We report our personal case series of 38 patients with Tuberculum sellae meningiomas; 36 patients under went craniotomy for tumor resection (12 bifrontal, 12 pterional, 6 supraciliary, 4 unilateral frontals, and 2fronto-orbito-zygomatic); in two patients, the excision was performed through an endoscopic endonasal approach. The Simpson grade of meningioma resection as well as the non-visual morbidity and the mortality rates were analyzed. RESULTS: Thirty-one patients had Simpson grades 1 and 2 excisions, while seven had Simpson grade 4 excisions. The overall rate of non-visual morbidity was 13.15% (5 of 38 patients) and mortality was 5.3% (2 of 38). CONCLUSION: The primary symptom leading to the diagnosis of a Tuberculum sellae meningioma is visual compromise and the main goal of surgery is to achieve improvement of vision. Favorable outcomes were achieved with appropriate selection of surgical approach. More studies are necessary to define the prognostic factors for patients in this scenario.
Insulectomy is an established microsurgical technique for treatment of insular epilepsy refractory to clinical management. The insular origin of epilepsy is unusual. However with depth investigation through hybrid electrodes, it is becoming possible to improve its diagnosis. The authors emphasize the insular functions as well as the anatomical landmarks for surgery. The main complications and physiological basis are discussed.
RESUMO
Insulectomia é uma técnica cirúrgica bem estabelecida que tem sido cada vez mais usada para o tratamento de epilepsias insulares e peri-insulares refratárias ao tratamento medicamentoso. A investigação neurofisiológica por meio de eletrodios de profundidade tem demonstrado um aumento na incidência de casos com indicação cirúrgica. Os autores enfatizam as funções autonômicas insulares, bem como os limites anatômicos da ressecção. As principais complicações e bases fisiológicas para indicação serão discutidas.Palavras-chave: Ínsula; Insulectomia; Epilepsia do lobo temporal; Eletródios híbridos.
La insulectomía es una técnica microquirúrgica establecida para el tratamiento de la epilepsia refractaria al tratamiento farmacológico.El origen insular de la epilepsia es inusual, sin embargo, con la investigación a través de electrodos híbridos este tipo de epilepsia ha incrementado su diagnóstico. Los autores hacen hincapié en las funciones insulares, así como los puntos de referencia anatómicos para la cirugía. Se discuten las principales complicaciones y las bases fisiológicas para las indicaciones de cirugía.
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