Acta neurochirurgica
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Acta neurochirurgica · Apr 2010
Intramedullary low grade astrocytoma and ependymoma. Surgical results and predicting factors for clinical outcome.
The optimal time point for surgery of intramedullary spinal astrocytomas and ependymomas is often debated on, as predicting factors are poorly defined. The current single-institutional study was conducted to retrospectively analyze prognostic factors for postoperative functional outcome in these patients. ⋯ An MCS of less than 3 and a tumor extent of less than 5 levels are the most important factors for a favorable postoperative functional outcome. Therefore, surgery should be initiated before significant clinical symptomatology or substantial tumor growth occurs.
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Acta neurochirurgica · Apr 2010
Early acute hemispheric stroke after carotid endarterectomy. Pathogenesis and management.
A major stroke after carotid endareterectomy (CEA) is an event that should be managed according to a planned strategy. Literature data on this issue are not definitive. We reviewed our series in the attempt to define an algorithm of treatment if this complication occurs. ⋯ A major stroke after CEA is caused, in most of cases, by the acute ICA occlusion with or without intracerebral embolic occlusion. Reopening of the occluded ICA gives good results when intracerebral vessels are patent and when the occluded ICA is satisfactorily reopened. An algorithm of planned reactions in case of perioperative stroke is finally proposed.
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Acta neurochirurgica · Apr 2010
Case ReportsIsolated posterior spinal artery aneurysm causing intracranial acute subarachnoidal hemorrhage.
A case of an isolated posterior spinal artery aneurysm of the upper cervical spinal cord is presented. Spinal artery aneurysms that are not associated with other entities are extremely rare. ⋯ The aneurysm was successfully clipped. No other vascular abnormalities were seen.
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Acta neurochirurgica · Apr 2010
Case ReportsCongenital duplication of the superior sagittal sinus and parietal encephalocele after vacuum extraction delivery.
A newly-born infant with a congenital dural and bony defect and an associated short-segmented duplication of the superior sagittal sinus suffered from herniation and infarction of parietal brain tissue secondary to vacuum extraction. This ultimately led to the formation of a subgaleal cerebrospinal fluid (CSF) collection. ⋯ As the bony defect developed characteristics of a growing fracture later on, dural repair, transplantation of a split-bone flap and, finally, the insertion of a ventriculoperitoneal shunt became necessary. This case affirms that stringent indication and cautious usage of vacuum-assisted delivery is strongly recommended, especially in view of the possibility that undetected congenital cranial, vascular and/or cerebral alterations may be present.
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Acta neurochirurgica · Apr 2010
Case ReportsEctopic choroid plexus associated with trigeminal neuralgia: case report.
A 55-year-old man underwent a microvascular decompression procedure for a pharmacoresistant trigeminal neuralgia. Preoperative MRI showed a neurovascular conflict between the Vth nerve root and the superior cerebellar artery. ⋯ Since vascular decompression of the trigeminal root did not relieve the pain, we suggest that the presence of choroid plexus at the root entry zone of the nerve may have induced trigeminal neuralgia in this patient.