0000000000165211
AUTHOR
Christoph A. Tschan
PROSAIKA: A prospective multicenter registry with the first programmable gravitational device for hydrocephalus shunting
Abstract Objective Cerebrospinal fluid (CSF) overdrainage is a major problem in shunt therapy for hydrocephalus. The adjustable gravitational valve proSA allows for the first time a targeted compensation for overdrainage in the upright position without interfering with the differential pressure valve. To evaluate benefit, safety and reliability, the multicenter prospective registry PROSAIKA was conducted in 10 German neurosurgical centers. Methods Between March 2009 and July 2010, 120 hydrocephalic patients undergoing first time shunt implantation or shunt revision using proSA entered the study. 93 patients completed the 12 months follow-up. Results Hydrocephalus symptoms were improved in 8…
First clinical results with a new telemetric intracranial pressure-monitoring system.
Background The knowledge of intracranial pressure (ICP) is the basis of an appropriate neurosurgical treatment. Because clinical, fundoscopic, or radiological data alone are often elusive, a pre- or postoperative long-term monitoring of the ICP itself is desirable. Objective We describe the first clinical experiences with a new telemetric ICP-monitoring device. Methods The transducer of this telemetric intraparenchymal pressure probe is placed under the galea over the calvaria. ICP can be monitored via a special telemetric reader, placed over the intact skin, and the ICP values are stored in a small portable computer. The system does not require an intensive care environment and can be used…
New applicator improves waterjet dissection quality
Waterjet dissection is accomplished with Helix Hydro-Jet, but a new device with improved operative handling and potentially superior dissection qualities has been developed.Eighty-four fresh cadaveric pig brains were simultaneously cut with Helix Hydro-Jet and Erbejet 2. A commonly used applicator and a new applicator for the Helix Hydro-Jet were directly compared to the new Erbejet 2. Under standardised conditions, different pressure levels were applied to the brain surface without arachnoids. Technical features, cutting depth, tissue damage and differences of applicators were examined.Microscopic analysis of cutting depth revealed different dissection characteristics of both the devices. …
Safety and Efficacy of Microporous Polysaccharide Hemospheres in Neurosurgery
BACKGROUND: Effective hemostasis is mandatory for brain tumor surgery. Microporous polysaccharide hemosphere (MPH) powder, a white powder compounded from potato starch, was recently introduced for surgical and emergency application. OBJECTIVE: To evaluate the safety and efficacy of MPHs in brain tumor surgery. METHODS: Thirty-three patients (mean age, 58 years; range, 22-84 years) underwent microsurgical brain tumor resection. Final hemostasis was performed by topical application of MPHs, video recorded, and subsequently analyzed. Blood samples were taken before surgery, before application of hemospheres, and postoperatively. Volume measurements of the tumor, resection cavity, and postopera…
Waterjet dissection in pediatric cranioplasty
Object Waterjet dissection has been shown to separate tissues of different resistance, with preservation of blood vessels. In cranioplasty, separation of subcutaneous tissue and dura mater is often difficult to achieve because the various tissue layers strongly adhere to each other after decompressive craniotomy. In the present study, the potential advantages and drawbacks of the waterjet technique in cranioplasty after craniectomy and duraplasty are addressed. Methods The waterjet effect on fresh human cadaveric dura mater specimens as well as on several dural repair patches was tested in vitro under standardized conditions, with waterjet pressures up to 80 bar. Subsequently, 8 pediatric …
Waterjet Dissection of Peripheral Nerves: An Experimental Study of the Sciatic Nerve of Rats
BACKGROUND: Although waterjet dissection has been well evaluated in intracranial pathologies, little is known of its qualities in peripheral nerve surgery. Theoretically, the precise dissection qualities could support the separation of nerves from adjacent tissues and improve the preservation of nerve integrity in peripheral nerve surgery. OBJECTIVE: To evaluate the potential of the new waterjet dissector in peripheral nerve surgery. METHODS: Waterjet dissection with pressures of 20 to 80 bar was applied on the sciatic nerves of 101 rats. The effect of waterjet dissection on the sciatic nerve was evaluated by clinical tests, neurophysiological examinations, and histopathological studies up …