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Objectives: The aim of our study was to evaluate minimally invasive techniques for the treatment of anterior circulation aneurysms versus standard surgery, and to calculate the impact of these techniques on health resources, length of stay, and treatment costs. Methods: A consecutive series of 24 patients with ruptured and 30 with unruptured anterior circulation aneurysms treated with minimally invasive microsurgery (MIM) by the same surgeon was compared with a matched series of standard microsurgeries (SM) conducted for 23 ruptured and 22 unruptured aneurysms. Complication rates, aneurysm obliteration, modified Rankin Scale (mRS) outcomes, length of stay, and treatment costs were assessed. Results: Surgical complications, aneurysm obliteration rates and mRS outcomes were comparable between MIM and SM groups in ruptured and unruptured aneurysm cohorts. MIM resulted in shorter operative times both in unruptured (102.7 ± 4.35 vs 194.7 ± 10.26 min, p < 0.0001) and ruptured aneurysms (124.3 ± 827 vs 209 ± 13.84 min, p < 0.0001). Length of stay was reduced in patients with MIM for unruptured aneurysms (1.55 ± 24 vs 4.28 ± 0.71 days, p < 0.000,1) but not in those with ruptured aneurysms. MIM reduced treatment costs of unruptured aneurysm patients, mainly through reduced utilization of inpatient resources (non-acute bed costs in CAD: 371.2 ± 80.99 vs 1440 ± 224.1, p < 0.0001), whereas costs were comparable in patients with ruptured aneurysms. Conclusion: Minimally invasive surgery is a safe and effective approach for the treatment of ruptured and unruptured aneurysms of the anterior circulation. In patients with unruptured aneurysms, reduced invasiveness and shorter operative times decreased length of stay, which reflects improved patient postoperative recovery. Overall, this translated into bed resource economy and cost reduction. [ABSTRACT FROM AUTHOR]

As a result of the increasingly popularity of vagal nerve stimulation (VNS) for intractable seizures, neurosurgeons not uncommonly encounter cases which require electrode revision. We examine our experience of VNS revision and reports the use of the ultra-sharp monopolar tip for safe dissection and removal of the electrode from the vagus nerve. A retrospective review was performed from January 2000 to Dec 2009 reviewed eight cases of VNS revision. The indications for VNS revision were device malfunction manifesting with increased seizures or increased impedance of the device and infection. The time from initial VNS implantation to revision ranged from 6 to 108 months (mean: 38 months). The entire VNS electrode system, was removed in seven cases and the helical coils were left in-situ in one case who did not derive any benefit from VNS and it was deemed unnecessary to subject the patient to the additional risk of vagal nerve injury. One case had dislodgement of the lower two coils and three cases had dense scarring to the vagus nerve causing high impedance and malfunction. The other three cases demonstrated no fibrotic scar tissue between the helical coils and the vagus nerve. Four cases had replacement of new VNS system but the case of infected VNS stimulator was not replaced as there was no benefit from the device. VNS revision is normally performed in cases of device malfunction or infection and can be safely performed using a combination of ultra-sharp monopolar coagulation and sharp dissection. [ABSTRACT FROM AUTHOR]