Clinical Neuroscience

[Anatomical basis of endoscopic ventriculostomy - clinical application of the free hand technique]

RESISCH Róbert1, PATONAY Lajos2, JULOW Jenő3

MAY 20, 1997

Clinical Neuroscience - 1997;50(05-06)

[The anatomical basis of the "free hand” technique in treatment of occlusive internal hydrocephalus, viz. endoscopic ventriculostomy, is discussed. In 25 cadavers the cella media of the lateral ventricle was endoscopically approached through a frontoparietal (15 cases), frontal (5) and biportal coronal (5) burr hole. Using the identified structure of the choroid plexus the foramen of Monro was investigated. Via this route, the endoscope advanced into the 3rd ventricle, then the localization of ventricular perforation was determined by first visualizing the mamillary bodies and the infundibular recess. Ventricular anatomy was also investigated in 50 fixed human brains. Between October and December 1995 endoscopic ventricular fenestration using a frontoparietal burr hole was performed on 3 patients without stereotactic localization. In one case the serious condition of the patient, in the other two cases the enormous supratentorial hydrocephalus required the application of the free hand technique. ]

AFFILIATIONS

  1. Semmelweis Orvostudományi Egyetem Anatómiai Intézet
  2. Szent Rókus Kórház, Arc- és Állcsontsebészeti Osztály
  3. Szent János Kórház, Idegsebészeti Osztály, Budapest

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[Effects of induction doses of thiopental and propofol on median nerve somatosensory evoked potentials and cerebral blood flow velocity were investigated in 50 patients suffering from degenerative lumbar spine diseases before operation and during anaesthesia. The propofol influences the cerebral electric activity and the blood flow velocity to a less extend than thiopental. Based on our results we prefer to employ propofol during neurosurgical procedures when using intraoperativ somatosensory evoked potentials and/or transcranial Doppler monitoring. ]

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[The purpose of our study was to evaluate the role of three dimensional time of flight magnetic resonance angiography in detection of neurovascular compression in patients with trigeminal neuralgia. 53 patients (26 males, 27 females mean age 57 years) with trigeminal neuralgia underwent 3D TOF MRA. Examinations were performed on 0.5 T Elscint Gyrex V Dlx equipment. The imaging parameters were 33-38/9/25 TR/TE/flip angle with 30-50 mm slab thickness and 1-1.5 mm slice thickness. Contrast material was administered in every case. Maximum intensity projection and thin slice reconstruction (pixel by pixel) were performed in three standard directions (axial, coronal and sagittal). To evaluate the presence or absence of vascular contact, we used both the source slices and reconstructed pictures. Vascular contact with the trigeminal nerve in the entry zone was identified on the symptomatic side in 26 cases (superior cerebellar artery in 20, superior cerebellar artery and vein in one, anterior inferior cerebellar artery in 2, basilar artery or a vein in 1-1 case) and on the asymptomatic side in 3 cases (superior cerebellar arteries). No contact was detected in 24 patients. The examination was not of diagnostic value in three cases, because of head motion artefacts. Veins were better visualized on the contrast pictures. Microvascular decompression sec. Janetta was performed in 9 cases. The surgical and neuroradiological findings were identical in every case. Complete pain relief or significant diminshing of the symptoms were achieved following surgery in all patients. 3D TOF MRA is a useful method in demonstration of vascular contact with the trigeminal nerve at the entry zone, which is valuable information in planning surgical treatment for patients with trigeminal neuralgia.]

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