OBJECTIVETo present the authors' experience with percutaneous dilatational tracheostomy (PDT), with special attention to early and late complications, outcomes, and primary disease influence.

METHODSBetween November 2000 and May 2001, 22 PDTs were performed with the aid of dilatating forceps in 21 neurosurgical coma patients. A Seldinger wire was introduced through a cannula into the trachea serving as a guide. The guidewire was threaded through the clamped guidewire dilating forceps and the forceps was advanced through the tracheal wall. The trachea was dilated by opening forceps. The guidewire was then threaded through the obturator of the tracheostomy tube and both were advanced into the trachea. Demographic data, patient disease variables and patient anatomical features, as well as perioperative and late complications were recorded prospectively.

RESULTSCompletion of the procedure consumed 4 - 16 minutes (mean, 12 minutes). The procedure caused complications in 3 operations: 2 cases of stomal bleeding, 1 of intratracheal bleeding, but there was no severe tracheal injury or mediastinal emphysema. Furthermore, none of the cases required intervention due to complications. All patients were followed up for 1 to 6 months. Tracheostomy tubes were removed in 16 patients. All cervical incisions were closed with cosmetic demand. Two patients with tracheostomy tubes were retained for primary diseases. Causes of death in 3 others were unrelated to the PDT. No patient developed tracheomalacia or tracheal stenosis as a late complication.

CONCLUSIONSPercutaneous dilatational tracheostomy is a fast, safe and simple procedure for neurosurgical coma patients and can be safely performed by neurosurgeons.

Adult ; Aged ; Coma ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; Tracheostomy ; adverse effects ; methods

Brain Stem ; pathology ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; adverse effects ; Postoperative Complications ; Subdural Effusion ; complications

OBJECTIVETo report the serious complications of microvascular decompression and (or) selective neurectomy in cerebellopontine angle.

METHODSTo review 322 cases of microvascular decompression and (or) facial nerve splitting, selective neurectomy for hemifacial spasm, trigeminal neuralgia and glossopharyngeal neuralgia respectively. Among 322 cases, hemifacial spasm 164, which 96 underwent facial nerve splitting, 68 underwent microvascular decompression and facial nerve splitting. The selective neurectomy and neurectomy were performed in 128 cases of trigeminal neuralgia and 30 cases for glossopharyngeal neuralgia respectively.

RESULTSOf the serious complications 2 died (0.6%), The mild to severe hearing impairment occurred in 21 cases (6.5%), in which 3 cases presented total hearing loss (0. 9%); Postoperative cerebellospinal leakage in 20 (6. 2%).

CONCLUSIONSIt was demonstrated that, even though the microvascular decompression and /or neurectomy was a safe procedure for posterior neuropathy, mortal and serious complications might occur. It was essential to pay great attention to the entire decompression procedure in avoiding cerebellar injury. Using of intraoperative ABR and avoiding of impairment of the acoustic nerve might contribute to the prevention of the postoperative hearing loss.

Adult ; Aged ; Cerebellopontine Angle ; surgery ; Decompression, Surgical ; adverse effects ; Female ; Hearing Loss ; etiology ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; adverse effects ; Postoperative Complications

Tension pneumocephalus is a rare but treatable neurosurgical emergency. Prompt and accurate diagnosis of tension pneumocephalus requires a high index of clinical suspicion corroborated by imaging. Herein, we describe a case of extensive tension pneumocephalus in a patient who had undergone transsphenoidal surgery and repair of the sellar floor, with subsequent successful decompression. This case report discusses the pertinent imaging features of tension pneumocephalus and its management.
Aged ; Craniopharyngioma ; surgery ; Decompression, Surgical ; methods ; Humans ; Male ; Neurosurgical Procedures ; adverse effects ; Pneumocephalus ; diagnosis ; diagnostic imaging ; Postoperative Complications ; Reproducibility of Results ; Tomography, X-Ray Computed

Recent years have seen an increasing incidence of prostate cancer (PCa) and a more frequent occurrence of the disease in younger men. Damage to cavernous nerves caused by radical prostatectomy is the main reason for post-operative erectile dysfunction. So reconstruction of cavernous nerves at the time of radical prostatectomy may restore the patient's erectile function. At present, clinical studies of using autologous sural nerve grafts to bridge transected cavernous nerves have achieved modest success, and laparoscopic sural nerve grafting during radical prostatectomy has also been proved safe and feasible. Besides, various grafts have been used to reconstruct cavernous nerves in animal models, among which biodegradable conduits containing growth-promoting factors or cells are a promising option for the repair of damaged cavernous nerves.
Animals ; Erectile Dysfunction ; etiology ; surgery ; Humans ; Male ; Nerve Regeneration ; Neurosurgical Procedures ; methods ; Penis ; innervation ; Prostatectomy ; adverse effects ; Prostatic Neoplasms ; surgery ; Rats ; Sural Nerve ; transplantation

Ischemic neurological injury is the most feared complication of spinal deformity surgery.In recent years, more attention has been paid to ischemic neurological injury during spinal deformity surgery including causes, risk factors, and prevention. The direct and indirect causes of ischemic neurological injury contains ligature of the segmental arteries, perioperative bleeding and excessive stretching or shortening of the spinal cord.Those patients at greatest risk for paraplegia following diagnosis of thoracic kyphosis or kyphoscoliosis, unilateral vessel ligation, perioperative hypotension, and extensive anterior and posterior surgery. Keeping reasonable mean arterial pressure and multimodal intraoperative monitoring may effectively prevent ischemic neurologic injury during surgery for spinal deformity.
Arteries ; Humans ; Ischemia ; physiopathology ; Kyphosis ; surgery ; Ligation ; Monitoring, Intraoperative ; Neurosurgical Procedures ; adverse effects ; Paraplegia ; Risk Factors ; Scoliosis ; surgery ; Spinal Cord Injuries

To seek a reasonable microsurgical technique for dorsal wall aneurysms in the internal carotid artery (ICA), and to evaluate its efficacy.
 Methods: A total of 21 patients with dorsal wall aneurysms in the ICA who received microsurgical techniques were retrospectively analyzed. The directive surgical clapping was applied for saccular aneurysm, while the techniques of stitching and wrapping, simple wrapping, and trapping with extracranial-intracranial bypass were used for cystic and blood blister false aneurysms.
 Results: One patient died after operation, 1 patient suffered rebleeding and gave up treatment, the remaining 19 patients achieved saticfactory outcomes.
 Conclusion: According to types of aneurysm wall, the different microsurgical treatments should be applied, and good outcomes can be achieved for patients with dorsal wall aneurysms in the ICA.
Adult ; Aneurysm, False ; surgery ; Carotid Artery, Internal ; surgery ; Female ; Humans ; Intracranial Aneurysm ; mortality ; surgery ; Male ; Microsurgery ; adverse effects ; methods ; mortality ; Middle Aged ; Neurosurgical Procedures ; adverse effects ; Postoperative Hemorrhage ; etiology ; Retrospective Studies ; Treatment Outcome

Adult ; Analgesics, Opioid ; administration & dosage ; pharmacology ; Anesthesia, General ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; Postoperative Complications ; drug therapy ; prevention & control ; Shivering ; drug effects ; Tramadol ; administration & dosage ; therapeutic use

Mixed autonomic hyperactivity disorder (MAHD) among patients with acquired brain injury can be rare. A delayed diagnosis of MAHD might exacerbate the clinical outcome and increase healthcare expenses with unnecessary testing. However, MAHD is still an underrecognized and evolving disease entity. A 25-yr-old woman was admitted the clinic due to craniopharyngioma. After an extensive tumor resection, she complained of sustained fever, papillary contraction, hiccup, lacrimation, and sighing. An extensive evaluation of the sustained fever was conducted. Finally, the cause for MAHD was suspected, and the patient was successfully treated with bromocriptine for a month.
Adult ; Brain/radionuclide imaging ; Bromocriptine/*therapeutic use ; Craniopharyngioma/complications/diagnosis/surgery ; Female ; Fever/complications/*drug therapy ; Hormone Antagonists/*therapeutic use ; Humans ; Hyperkinesis/complications/*diagnosis ; Magnetic Resonance Imaging ; Neurosurgical Procedures/*adverse effects ; Pituitary Neoplasms/complications/diagnosis/surgery ; Tomography, X-Ray Computed

This study describes the neuropathologic features of normal canine brain ablated with non-thermal irreversible electroporation (N-TIRE). The parietal cerebral cortices of four dogs were treated with N-TIRE using a dose-escalation protocol with an additional dog receiving sham treatment. Animals were allowed to recover following N-TIRE ablation and the effects of treatment were monitored with clinical and magnetic resonance imaging examinations. Brains were subjected to histopathologic and ultrastructural assessment along with Bcl-2, caspase-3, and caspase-9 immunohistochemical staining following sacrifice 72 h post-treatment. Adverse clinical effects of N-TIRE were only observed in the dog treated at the upper energy tier. MRI and neuropathologic examinations indicated that N-TIRE ablation resulted in focal regions of severe cytoarchitectural and blood-brain-barrier disruption. Lesion size correlated to the intensity of the applied electrical field. N-TIRE-induced lesions were characterized by parenchymal necrosis and hemorrhage; however, large blood vessels were preserved. A transition zone containing parenchymal edema, perivascular inflammatory cuffs, and reactive gliosis was interspersed between the necrotic focus and normal neuropil. Apoptotic labeling indices were not different between the N-TIRE-treated and control brains. This study identified N-TIRE pulse parameters that can be used to safely create circumscribed foci of brain necrosis while selectively preserving major vascular structures.
Animals ; Brain/metabolism/*pathology/surgery/ultrastructure ; Caspase 3/metabolism ; Caspase 9/metabolism ; Dogs ; Electroporation/veterinary ; Magnetic Resonance Imaging/methods ; Microscopy, Electron, Transmission ; Necrosis/metabolism/pathology ; Neurosurgical Procedures/*adverse effects