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    Orbital head pain elicited by neuroendoscopy of the third ventricle performed under local anesthesia

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    Endoscopic third ventriculostomy (ETVS) is considered a minimally invasive procedure for blocked hydrocephalus. In 24 cases, this procedure was carried out in awake patients under local anesthesia. All patients reported abrupt orbital pain when the third ventricle floor was manipulated. Although recent advancements in knowledge of some forms of migraine and cluster headache could be regarded as a good basis for interpreting the pain triggered by ETVS, other hypotheses should also be taken into consideration

    A simplified endoscopic third ventriculostomy under local anesthesia

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    The aim of this study is the analysis of our experience with awake endoscopic third ventriculostomy (ETVS) in hydrocephalic patients. From September 1994 to December 2001, 24 neuroendoscopic procedures were performed under local anesthesia. Local infiltration was administered using a bupivacaine and lidocaine mixture. Analgesics were titrated to the effect. A free-hand technique with a flexible endoscope was adopted in 24 patients with primitive and secondary (neoplastic) hydrocephalus. ETVS was performed successfully in all cases. No procedure needed to be discontinued due to seizures, bleeding or agitation. Dural incision/coagulation and Fogarty dilatation proved to be the most painful maneuvers requiring, sometimes, supplemental analgesic administration. No intraoperative complications were observed; however, two asymptomatic trajectory hematomas were incidentally discovered two and three days after the operation, respectively. Awake ETVS is a valuable alternative procedure that can be adopted in adult cooperative patients, provided that the procedure is done in an essential and fast way with the free-hand technique, by means of a flexible endoscope, and with the assistance of an anesthesiologist

    Day surgery: the value of monitored anesthesia care and intraoperative monitoring

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    Day surgery: the value of monitored anesthesia care and intraoperative monitorin

    Il trattamento del dolore post-operatorio mediante analgesia spinale bilanciata.

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    Gli autorio analizzano il trattamento del dolore post-operatorio mediante analgesia spinale bilanciata
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