March 18, 2013, 17:55

February 27, 2013, 18:58

February 27, 2013, 0:00

Zahra Emami, Najme-Sadat Moosavi, Majid Karimi, Alexander R Vaccaro, Vafa Rahimi-MovagharSurgical Neurology International 2013 4(1):25-25Background: Sacral nerve stimulation is a minimally invasive procedure to treat spinal cord injured (SCI) patients ...

February 20, 2013, 0:00

Noriaki Sakamoto, Hiroyoshi Akutsu, Shingo Takano, Tetsuya Yamamoto, Akira Matsumura

Surgical Neurology International 2013 4(1):19-19

Background: Postoperative cerebrospinal fluid (CSF) leakage is a major problematic complication after extended transsphenoidal surgery (TSS). Watertight closure of the sellar dura with a fascial patch graft is a method of choice for preventing CSF leakage; however, suturing and knotting in a deep and narrow operative field is technically challenging and time consuming. To present a simple and effective knotting technique named the 'sliding-lock-knot' technique, in which the knot can easily be slid to the suturing point and tied automatically using only a single string, without loosening. Methods: We use a 6-0 nylon suture and Mosquito forceps. At first, after putting a stitch, a single knot is made by hand out of the nasal cavity. Then the 'sliding-lock-knot' is made using a forceps as shown in the illustration. The knot slides deep into the operative field through the nostril and it is automatically tied only by pulling a string. Results: A 73-year-old woman presented with progressive visual deterioration. She had an intra-and suprasellar craniopharyngioma that was compressing the optic chiasm. She underwent an extended TSS, and the tumor was totally resected. The dural defect was closed with a fascial patch graft sutured on the dura using this technique, then covered with a vascularized mucoseptal flap. Neither CSF leakage nor meningitis was encountered during the postoperative period. Conclusion: The 'sliding-lock-knot' technique is simple and useful for dural suturing in microscopic/endoscopic extended TSS. This technique is a helpful tool for preventing CSF leakage after this challenging surgical procedure.

January 28, 2013, 0:00

Roberto Stefini, Giacomo Esposito, Bruno Zanotti, Corrado Iaccarino, Marco Maria Fontanella, Franco Servadei

Surgical Neurology International 2013 4(1):12-12

Background: Cranioplasty is a surgical intervention aimed at reestablishing the integrity of skull defects, and should be considered the conclusion of a surgical act that began with bone flap removal. Autologous bone is still considered the treatment of choice for cranioplasty. An alternative choice is bioceramic porous hydroxyapatite (HA) as it is one of the materials that meets and comes closest to the biomimetic characteristics of bone. Methods: The authors analyzed the clinical charts, compiled by the neurosurgeon, of all patients treated with custom-made porous HA devices (Custom Bone Service Fin-Ceramica, Faenza) from which epidemiological and pathological data as well as material-related complications were extrapolated. Results: From November 1997 to December 2010, 1549 patients underwent cranioplasty with the implantation of 1608 custom-made porous HA devices. HA was used in 53.8% of patients for decompressive craniectomy after trauma or intracranial hemorrhage, while the remaining cases were for treated for comminuted fracture, cutaneous or osseous resection, cranial malformation, autologous bone reabsorption or infection or rejection of previously implanted material. The incidence of adverse events in patients treated for cranioplasty, as first line treatment was 4.78% (56 events/1171 patients), and 5.02%, (19 events/378 patients) at second line. Conclusion: This study demonstrates that HA is a safe and effective material, is well tolerated in both adult and pediatric patients, and meets the requirements necessary to repair craniolacunia.

January 17, 2013, 22:34

December 26, 2012, 18:57

December 14, 2012, 0:00

Pieter L Kubben, Nader Pouratian

Surgical Neurology International 2012 3(1):149-149

Brain Computer Interfaces (BCIs) have focused on several areas, of which motor substitution has received particular interest. Whereas open-source BCI software is available to facilitate cost-effective collaboration between research groups, it mainly focuses on communication and computer control. We developed an open-source and cross-platform framework, which works with cost-effective equipment that allows researchers to enter the field of BCI-based motor substitution without major investments upfront. It is based on the C++ programming language and the Qt framework, and offers a separate class for custom MATLAB/Simulink scripts. It has been tested using a 14-channel wireless electroencephalography (EEG) device and a low-cost robotic arm that offers 5° of freedom. The software contains four modules to control the robotic arm, one of which receives input from the EEG device. Strengths, current limitations, and future developments will be discussed.

December 14, 2012, 0:00

Danilo Otávio de Araújo Silva, Georgios K Matis, Leonardo Ferraz Costa, Matheus Augusto Pinto Kitamura, Eduardo Vieira de Carvalho Junior, Monalisa de Moura Silva, Breno José A. P. Barbosa, Carlos Umberto Pereira, Joacil Carlos da Silva, Theodossios A Birbilis, Hildo Rocha Cirne de Azevedo Filho

Surgical Neurology International 2012 3(1):150-150

Background: To present the accumulated experience from treating chronic subdural hematomas (CSDH) in a local hospital of a third world country. Methods: One hundred and twenty-five consecutive patients with CSDH who were surgically treated in the Neurosurgical Department of the Hospital da Restaura&#231;&#227;o, Recife-PE, Brazil, between January 2006 and May 2008, were retrospectively studied. Glasgow Outcome Scale (GOS) was employed to define outcome at 6 months as good (GOS 4 and 5) or poor (GOS &#8804; 3). Age, admission Glasgow Coma Scale (GCS), location of hematomas (unilateral/bilateral), drainage system placement and recurrence were all analyzed for potential impact on final outcome. Results: The median age was 69 years, with a male/female ratio of 102/23. History of trauma was present in 60.8% of the patients. The median GCS on admission was 14. In 64 patients, the hematoma was on the left side, while in 42 patients it was on the right side. Bilateral hematomas were present in 19 cases (15.2%). Drainage systems were used in 93.6% of the cases. Recurrence occurred in 8.8% of the patients. One hundred and three patients obtained a good outcome at 6 months. The mortality rate was 11.2%. Patients with GCS &#8805;9 on admission presented better outcome ( P < 0.05). Recurrent cases presented a poor outcome ( P < 0.05). Conclusions: This study suggests that the main factors associated with outcome in patients harboring CSDH are the admission GCS score and the recurrence status. Advanced age is not a contraindication for surgical treatment. This study, solely focused on the Brazilian population, is the first of its kind in the English literature, and it could serve as a useful introduction to a more complex, multivariate, debate.

December 14, 2012, 0:00

Ben RoitbergSurgical Neurology International 2012 3(1):154-154