7 research outputs found
The lumbar interbody fusion using cortical bone trajectory pedicle screws: clinical results of the lumbar degenerative spondylosis surgical treatment
Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. The Midline lumbar interbody fusion (MIDLIF) uses the cortical bone trajectory
(CBT) pedicle screws instead of the traditional pedicle screws. The CBT screw follows a medial
to lateral path in the transverse plane and is tilted caudally in the sagittal plane. This technique is
minimally invasive, reinforces the screw pullout strength and reduces the approach-related
morbidity
Anesthetic and intensive care management in a transoral surgical approach of a patient with atlantoaxial dislocation
Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova,
Clinical Republican Hospital, Department of Anesthesiology and Intensive Care,
Clinical Republican Hospital, Department of NeurosurgeryBackground. Transoral approach is an advanced neurosurgical technique in the treatment of
atlantoaxial dislocation with spinal cord compression. Good cooperation between the surgical
and the anesthetic teams during the treatment of this pathology plays a key role in achieving a
positive result
Advances in multimodality treatment of cerebral aneurysms
Background: The treatment of intracranial aneurysms has undergone a paradigm shift such
that endovascular therapy has emerged as a viable treatment regimen. Thus, microsurgery
techniques have become less invasive, more appealing to patients, lower risk, and efficacious for
complex aneurysms, particularly those unfavorable for or failing endovascular therapy.
Methods: We reviewed literature and emphasized major modern techniques used in complex
aneurysm treatment. Also we present several cases of minimal invasive supraorbital „keyhole”
craniotomy, used in treatment of anterior circulation aneurysms and a case report of a giant cavernous
carotid aneurysm resolved with an extra-intracranial high-flow bypass and trapping of parent vessel.
Results: Multimodality treatment of cerebral aneurysm provided by literature can be divided
in two major groups: microsurgery and endovascular techniques. Microsurgery include: direct clip
occlusion via a large or minimal invasive craniotomy, clip occlusion after coil extraction and bypass
techniques; while endovascular techniques embrace: coiling, stent/balloon-assisted coiling and
pipeline endovascular device flow diverter.
Conclusion: Contemporary management strategies should involve all aspects of neurovascular care,
including neuroendovascular physicians, neurocritical care, and neuroanesthesia. All of these specialties should be synergistic and complementary in their approach with the common goal of managing the
obliteration of the aneurysm with minimal risk, both short-term and long-term, to the patient
Intraoperative Monitoring in Neurosurgery
Coordonator ştiinţific: Andronachi Victor
Institutul de Neurologie şi NeurochirurgieIONM is the application of a variety of electrophysiological and vascular monitoring procedures during surgery to allow early warning and avoidance of injury to nervous system structures.This article highlights advances in IOM technologies including the use of motor and somatosensory evoked potentials to assess the integrity of descending corticospinal and ascending somatosensory pathways, electromyography to assess the integrity of cranial nerves or spinal nerve roots, various approaches including brainstem auditory evoked potentials and cochlear nerve action potentials to enhance the safety of vestibular schwannoma surgery.
IOM este o metodă de evaluare a înregistrărilor activităţii electrofiziologice a structurilor nervoase şi a modificărilor fluxului sangvin cerebral cu scop de prevenire şi de evitare a afectării acestor structuri pe parcursul intervenţiei chirurgicale.
Acest articol reflectă rolul IOM prin determinarea potenţialelor evocate somato-senzoriale şi motorii folosite pentru a aprecia integritatea căilor de conducere ascendente şi descendente ale sistemului nervos, de asemenea electromiografia ca metodă de apreciere a integrităţii nervilor cranieni şi spinali. Înregistrarea potenţialelor evocate auditive sau potenţialele de trunchi cerebral prezintă utilitate prin reducerea riscului de lezare a nervului vestibulocochlear în caz de schwanom vestibular
Efficacy of cortical bone trajectory pedicle screw fixation in the treatment of patients with lumbar degenerative spondylolisthesis
Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Prima experiență clinică de aplicare a tehnicii de artrodeză intersomatică lombară mediană (MIDLIF) cu șuruburi cortico-pediculare în tratamentul chirurgical al instabilității spinale de origine degenerative, datează cu anul 2014. Dovezile științifice ale eficienței noii tehnici de artrodeză sunt limitate la studii retrospective, non-randomizate, pe eșantioane mici de pacienți și populații nereprezentative. Scopul lucrării. Evaluarea eficacității clinice și radio-imagistice ale tehnicii de artrodeză intersomatică MIDLIF aplicate exclusiv în tratamentul pacienților cu spondilolistezis degenerativ. Material și metode. A fost realizat un studiu controlat randomizat, pe un eșantion de 112 pacienți, repartizați egal în două loturi de studiu (MIDLIF vs. tehnica tradițională). Criteriul principal de comparație a fost rata de reușită a fuziunii intersomatice, evaluate prin tomografie computerizată. Criteriile secundare au inclus sindromului algic, gradul de handicap funcțional, calitatea vieții și parametrii asociați morbidității perioperatorii. Rezultate. Ambele tehnici chirurgicale analizate au fost asociate cu o rată foarte înaltă de reușită a artrodezei, diferența între loturi fiind statistic nesemnificativa (p>0.005). Tehnica MIDLIF a demonstrat rezultate semnificativ mai bune comparativ cu metoda convențională în ameliorarea scorului VAS pentru durerea lombară și radiculară, a scorului de dizabilitate ODI și a scorului SF-12 pentru calitatea vieții. De asemenea, tehnica MIDLIF a fost asociată cu o morbiditate chirurgicală semnificativ mai joasă, exprimată prin volum mai mic al hemoragiei, incizie mai scurtă și o durată mai mică a operației. Rata de complicații a fost echivalentă în ambele loturi de studiu. Concluzie. Artrodeza intersomatică MIDLIF este o metodă sigură și eficientă de tratament al pacienților cu spondilolistezis degenerativ.Background. The first clinical experience with the midline lumbar interbody fusion (MIDLIF) with cortico-pedicular screws dates back to 2014. Scientific evidence of the new arthrodesis technique efficacy is limited to retrospective, non-randomized studies involving small patient samples and non-representative populations. Objective of the study. To evaluate the clinical and radiological efficacy of the MIDLIF interbody arthrodesis technique used exclusively in the treatment of degenerative spondylolisthesis. Material and methods. A randomized controlled trial was performed on a sample of 112 patients, equally divided into two study groups (MIDLIF vs. traditional technique). The primary endpoint was the success rate of interbody fusion as assessed by CT scan. Secondary endpoints included pain syndrome, degree of functional disability, quality of life and the parameters associated with perioperative morbidity. Results. Both surgical techniques were associated with a very high rate of successful bony fusion, difference between groups being statistically insignificant (p>0.05). The MIDLIF technique showed significantly better results in improving the VAS score for lumbar and radicular pain, the ODI disability score and the SF-12 quality of life score. The MIDLIF technique was also associated with significantly lower surgical morbidity, expressed in lower estimated blood loss, shorter incision and shorter operative time. The complication rate was equivalent in both study groups. Conclusion. MIDLIF interbody arthrodesis is a safe and effective method of treating patients with degenerative spondylolisthesis
Boala Parkinson. Tratamentul stereotactic neurochirurgical ca tratament combinat
Scientific coordinator: Dan Lîsii
Institute of Neurology and NeurosurgeryPD is a chronic and progressive disorder of the central nervous system. For patients with Parkinson's disease who have become unresponsive to pharmacotherapy or have developed severe motor complications due to medical therapy, a number of symptomatic neurosurgical interventions are available: thalamotomy, thalamic stimulation and pallidotomy. Neurosurgical therapies may increasingly complement and extend pharmacologic management of Parkinson's disease.
Boala Parkinson este o boală degenerativă a sistemului nervos central. Pentru pacienții cu BP ce nu prezintă un raspuns pozitiv la tratamentul conservator - medicamentos, iar dereglarile motorii sunt datorate tratamentului farmacoterapeutic, sunt recomandate câteva abordari neurochirurgicale de stimulare cerebrală profundă şi lezională, acestea fiind: talamotomia, stimularea talamică și palidotomia. Tratamentul neurochirurgical în BP eventual intensifica, potențează și complimentează tratamentul farmacologic