Johannes Schramm's Advances and Technical Standards in Neurosurgery: Volume 42 PDF
By Johannes Schramm
This quantity of Advances and Technical criteria in Neurosurgery covers a few vital new advancements in sensible neurosurgery and endovascular remedy. within the Technical criteria part a number of themes are thought of, together with optic pathway gliomas, pineal lesions, cavernous sinus meningiomas and the everlasting challenge of youth and repetitive head damage. Endovascular therapy of a number of lesions is now universal perform and the cutting-edge in endovascular therapy for acute ischemic stroke is reviewed. An appraisal of the facts on no matter if there's a position for microsurgical vascular decompression for crucial high blood pressure increases fascinating questions. the amount is finished by way of contributions on neurosurgical remedy of cluster complications and occipital nerve stimulation.
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Additional info for Advances and Technical Standards in Neurosurgery: Volume 42
Forty-one percent of patients had an mRS score of ≤2 at 90 days compared to 25 % in the Pivotal trial. Although the postmarketing Penumbra data were not significantly different from the Pivotal trial data, the proportion of patients with a good functional outcome was higher than expected. A review of the Penumbra POST trial database did not reveal a definitive reason for the observed difference in outcome between the studies. However, it raised the intriguing possibility that it was at least partly attributable to an inherent variability in patient stroke pathophysiology at presentation.
The trial period is typically 4–7 days, Fig. 2 Intraoperative AP radiograph demonstrating stacked occipital percutaneous trial leads in a patient with hemicrania continua Occipital Nerve Stimulation 29 Fig. 3 AP radiograph demonstrating implanted stacked occipital leads and a cervical paddle electrode in a patient with chronic migraine and complex regional pain syndrome of the right upper extremity and patients are encouraged to maintain a headache or pain diary. Trial success is defined as greater than 50 % improvement in pain on the visual analog scale, significant reduction in headache days, or improvement in quality of life.
The entry point should be approximately 1 cm superior to the tip of the mastoid process, and the trajectory is towards the tip of the odontoid process. Trajectories superior to this are often used and are well tolerated. The electrode should be placed in the superficial aspect of the subcutaneous fat. Care should be taken to not place the lead in the dermis, nor too close to the fascia. The leads are secured to the skin with a 2-0 nylon drain stitch. The leads are then inserted into the trialing cable and programming commences.
Advances and Technical Standards in Neurosurgery: Volume 42 by Johannes Schramm