, 1981 Aron-Rosa D: Use of a pulsed neodynium-YAG laser for anterior capsulotomy before extracapsular cataract extraction. J Am Intraocul Implant Soc 7: 332–333, 1981 2. Ascher PW : Neurosurgery , in Andrews AH Jr , Polanyi TG (eds): Microscopic and Endoscopic Surgery with the CO 2 Laser. Boston/Bristol/London : John Wright-PSG , 1982 , pp 298 – 314 Ascher PW: Neurosurgery, in Andrews AH Jr, Polanyi TG (eds): Microscopic and Endoscopic Surgery with the CO 2 Laser. Boston/Bristol/London: John Wright
Michael S. B. Edwards, James E. Boggan and Terry A. Fuller
Rand M. Voorhies, Michael H. Lavyne, Timothy A. Strait and William R. Shapiro
or over the surgical field. The discrepancy in effects between the two laser systems may reflect differences in energy absorption, as suggested by Oosterhuis, et al. 5 Investigations of this potential problem should be carried out with the more modern neodymium yttrium-aluminum-garnet (Nd:YAG) lasers in neurosurgical use today. References 1. Ascher PW : Neurosurgery , in Andrews AH Jr , Polanyi TG (eds): Microscopic and Endoscopic Surgery with the CO 2 Laser. Boston/Bristol/London : John Wright-PSG , 1982
An 11-year experience in the CT era
Walter A. Hall and L. Dade Lunsford
the cyst. A free-hand puncture and catheter aspiration technique guided by intraoperative CT has been advocated by Gutierrez-Lara, et al. 11 Apuzzo, et al. , 2 advocated transventricular endoscopic removal of colloid cysts. 2 Transventricular endoscopic surgery may enhance evacuation of these lesions; we are currently exploring stereotaxic endoscopy or laser resection of colloid cysts as described by Kelly, et al. 12 In contrast to the potential risks of transfrontal and transcallosal surgery, we have found stereotaxic aspiration of colloid cysts to be
Ludwig M. Auer, Wolfgang Deinsberger, Kurt Niederkorn, Günther Gell, Reinhold Kleinert, Gerhard Schneider, Peter Holzer, Gertraude Bone, Michael Mokry, Eva Körner, Gertrude Kleinert and Susanna Hanusch
✓ A controlled randomized study of endoscopic evacuation versus medical treatment was performed in 100 patients with spontaneous supratentorial intracerebral (subcortical, putaminal, and thalamic) hematomas. Patients with aneurysms, arteriovenous malformations, brain tumors, or head injuries were excluded. Criteria for inclusion were as follows: patients' age between 30 and 80 years; a hematoma volume of more than 10 cu cm; the presence of neurological or consciousness impairment; the appropriateness of surgery from a medical and anesthesiological point of view; and the initiation of treatment within 48 hours after hemorrhage. The criteria of randomization were the location, size, and side of the hematoma as well as the patient's age, state of consciousness, and history of hypertension. Evaluation of outcome was performed 6 months after hemorrhage.
Surgical patients with subcortical hematomas showed a significantly lower mortality rate (30%) than their medically treated counterparts (70%, p < 0.05). Moreover, 40% of these patients had a good outcome with no or only a minimal deficit versus 25% in the medically treated group; the difference was statistically significant for operated patients with no postoperative deficit (p < 0.01). Surgical patients with hematomas smaller than 50 cu cm made a significantly better functional recovery than did patients of the medically treated group, but had a comparable mortality rate. By contrast, patients with larger hematomas showed significantly lower mortality rates after operation but had no better functional recovery than the medically treated group. This effect from surgery was limited to patients in a preoperatively alert or somnolent state; stuporous or comatose patients had no better outcome after surgery. The outcome of surgical patients with putaminal or thalamic hemorrhage was no better than for those with medical treatment; however, there was a trend toward better quality of survival and chance of survival in the operated group.
Meglio Beatrice Cioni Gian Franco Rossi April 1989 70 4 519 524 10.3171/jns.1989.70.4.0519 Treatment of colloid cysts of the third ventricle by stereotaxic microsurgical laser craniotomy Chad D. Abernathey Dudley H. Davis Patrick J. Kelly April 1989 70 4 525 529 10.3171/jns.1989.70.4.0525 Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study Ludwig M. Auer Wolfgang Deinsberger Kurt Niederkorn Günther Gell Reinhold Kleinert Gerhard Schneider
Approaches and long-term results in 144 patients
M. Gazi Yaşargil, Marijan Curcic, Mirjana Kis, Gertrud Siegenthaler, Peter J. Teddy and Peter Roth
the neurosurgeon. In order to be successful, he is forced to adapt himself and to adopt the techniques of endoscopic surgery ( Figs. 4 and 5 ). Fig. 4. Diagram in the sagittal plane showing the direction of approach (arrows) to a craniopharyngioma by the combined pterional-transcallosal route. Fig. 5. Drawing showing preferred craniotomy sites for pterional, transcallosal, and combined approaches. Arrows show the direction of approach to the craniopharyngioma. Combined Pterional-Transcallosal Approach If the findings on CT and
Louis F. D'Amelio, David J. Musser and Michael Rhodes
that of our patient, is weakness of the quadriceps group. The patellar reflex is absent or diminished, and anterior thigh or medial leg paresthesias can often be appreciated. Femoral nerve injury has been reported as a complication of many operative procedures including appendectomy, 7 renal transplantation, 14 tubal reconstruction, 13 vaginal hysterectomy, 6 and transurethral endoscopic surgery. 1 Both direct trauma and stretch injury secondary to retraction have also been reported as etiologies. Spiegel and Meltzer, 11 among others, have reported cases of
Comparative study based on serial CT and time-course analysis
Kazuhiko Fujitsu, Masato Muramoto, Yoshihiro Ikeda, Yoshinori Inada, Iru Kim and Takeo Kuwabara
recovery. Moreover, these patients are not always referred to a neurosurgical service early enough to be operated on at the optimal time. Nevertheless, precise analysis of time course and other factors is of practical use in the selection of that small number of surgical candidates and in securing them a decent quality of life. References 1. Auer LM , Deinsberger W , Niederkorn K , et al : Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 70 : 530 – 535
Carl B. Heilman and Alan R. Cohen
stereotaxis in the management of lesions of the third ventricular region. Neurosurgery 15 : 502 – 508 , 1984 Apuzzo MLJ, Chandrasoma PT, Zelman V, et al: Computed tomographic guidance stereotaxis in the management of lesions of the third ventricular region. Neurosurgery 15: 502–508, 1984 2. Auer LM , Deinsberger W , Niederkorn K , et al : Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 70 : 530 – 535 , 1989 Auer LM, Deinsberger W
Preliminary results comparing transcallosal microsurgery with endoscopy
Adam I. Lewis, Kerry R. Crone, Jamal Taha, Harry R. van Loveren, Hwa-Shain Yeh and John M. Tew Jr.
-transventricular microsurgery, transcallosal microsurgery, and now endoscopic surgery. Improvements in fiberoptic technology and instrumentation and increased surgical experience have led to further applications of endoscopy in neurosurgery. Since 1990, we have used a steerable fiberscope to remove colloid cysts in seven patients and have performed microsurgery via a transcallosal approach in eight patients. We compared the two techniques for operating time, days spent in the intensive care unit (ICU) and on the ward, incidence of complications, recurrence, and hydrocephalus, and length of