Acta neurochirurgica
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Acta neurochirurgica · Feb 2016
Radiosurgical considerations for cavernous sinus hemangioma: long-term clinical outcomes.
Cavernous hemangiomas are rare vascular tumors in the cavernous sinus. Cranial neuropathies induced by cavernous sinus hemangiomas (CSH) necessitate tumor reduction, but surgery is extremely difficult due to the abundant vascularization of the lesion. We studied the effectiveness and safety of Gamma Knife radiosurgery (GKRS) for CSH. ⋯ The optimal treatment for CSH has been unclear; however, in this study, GKRS was an effective and safe treatment for CSH. Thus, GKRS may be a primary treatment for CSHs in high-risk surgery patients.
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Acta neurochirurgica · Feb 2016
Morphometric analysis of the medial opticocarotid recess and its anatomical relations relevant to the transsphenoidal endoscopic endonasal approaches.
The medial opticocarotid recess (MOCR) is located in the posterior wall of the sphenoid sinus, medial to the junction of the optic canal (OC) and the carotid prominence (CP). There is controversy in the literature in relation to the presence of the MOCR and its constancy, which is relevant when approaching the skull base through an endoscopic route. ⋯ The MOCR may be used as a reference point for precise location of structures during EEA. Objective measurements may be especially useful in cases with distorted sphenoid bone anatomy.
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Acta neurochirurgica · Feb 2016
Case ReportsTreatment strategy for cerebral hypotension caused by spontaneous cerebrospinal fluid leaks.
Spontaneous spinal cerebrospinal fluid (CSF) leaks are rare (5 per 100,000 per year). Treatment generally consists of conservative therapy or interventional therapy with epidural blood patching. Surgical treatment is conducted rarely, usually in cases when conservative or interventional treatment has failed. The aim of our case series was to assess the clinical outcome after surgery. ⋯ Preoperative identification of a CSF leak with MRI was positive in only one case. In all other cases, a post-myelography CT had to be performed. In all cases, the preoperative symptoms improved after surgery. Surgical treatment is an effective treatment of spontaneous cerebrospinal fluid leaks in cases of refractory symptoms after failed conservative or interventional treatment.
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Acta neurochirurgica · Feb 2016
Assessment of non-invasive ICP during CSF infusion test: an approach with transcranial Doppler.
This study aimed to compare four non-invasive intracranial pressure (nICP) methods in a prospective cohort of hydrocephalus patients whose cerebrospinal fluid dynamics was investigated using infusion tests involving controllable test-rise of ICP. ⋯ Out of the four methods, nICP_PI was the one with best performance for predicting changes in ∆ICP during infusion test, followed by nICP_BB. Unreliable correlations were shown by nICP_FVd and nICP_CrCP. Changes of ICP observed during the test were expressed by nICP values with only moderate correlations.
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Acta neurochirurgica · Feb 2016
Perioperative monitoring of pulsatile and static intracranial pressure in patients with Chiari malformation type 1 undergoing foramen magnum decompression.
Patients with Chiari malformation type 1 (CMI) often present with elevated pulsatile and static intracranial pressure (ICP). The preferred treatment of CMI, foramen magnum decompression (FMD), is assumed to normalise ICP and craniospinal pressure dissociation. In order to further explore the mechanisms behind FMD, the present study investigated whether or not pulsatile and static ICP normalises immediately after FMD. ⋯ The present observations suggest that anatomical restoration of cerebrospinal fluid pathways by FMD does not lead to immediate normalisation of preoperatively altered pulsatile and static ICP in patients with CMI. This finding may explain persistent symptoms during the early period after FMD.