Acta neurochirurgica
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Acta neurochirurgica · Jan 1997
Case ReportsRuptured vertebrobasilar junction aneurysm associated with basilar artery fenestration.
A case of a ruptured saccular aneurysm arising from the proximal portion of a partially duplicated basilar artery in a 36-year-old woman is reported. CT and lumbar puncture confirmed subarachnoid haemorrhage. ⋯ The patient underwent successful clipping and coating of the aneurysm by a right lateral suboccipital osteoclastic approach. Embryological development, pathogenesis, diagnostic and therapeutic difficulties of this vascular malformation are discussed in this report.
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Acta neurochirurgica · Jan 1997
Benign neural sheath tumours of major nerves: characteristics in 119 surgical cases.
Peripheral benign nerve sheath tumours are infrequent tumours and affect major nerve trunks. Some authors have indicated a high and prohibitive incidence of neurological injury in resection of these lesions. The authors describe their findings in a retrospective study comprising 119 patients with spontaneous benign nerve sheath tumours of the peripheral nervous system. ⋯ All plexiform neurofibromas were removed subtotally and the outcome for patients was 20% improved and 80% unchanged. The best surgical results at average follow-up of 6 years were observed in the patients with schwannoma, the worst in those with plexiform neurofibroma. Our results demonstrated that it is often possible to remove schwannomas as well as neurofibromas with an acceptable risk of injury to the nerve.
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Acta neurochirurgica · Jan 1997
S-100 protein plasma levels after aneurysmal subarachnoid haemorrhage.
We investigated the level of S-100 protein in blood as an indicator of brain damage in 71 patients suffering from subarachnoid haemorrhage (SAH) due to ruptured aneurysms. Concentrations of S-100 protein were determined by micro-titre based immunofluorometic assay detecting predominantly S-100b on blood samples obtained 24 hours, 3 days and 7 days after onset of symptoms in patients with SAH and from 120 healthy control subjects. Neurological status was assessed using the Hunt and Hess (HH) scale on admission and by the Glasgow Outcome Scale (GOS) 6 months later. ⋯ Worse outcome (lower GOS score) 6 months after SAH was also associated with higher plasma concentration of S-100 in the first week after SAH. In summary, this study showed that in patients with SAH due to ruptured aneurysm, S-100 protein levels correlate with early neurological deficit and are as sensitive as HH scores in predicting neurological outcome (GOS scores). Measurement of S-100 protein in blood is a reliable non-invasive method and may be clinically useful to screen for and monitor progression of central nervous system diseases of various origins.
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Acta neurochirurgica · Jan 1997
Case ReportsInitial and postoperative hyponatremia associated with pituitary adenoma: a case report.
This 67 year-old man experienced 3 episodes of symptomatic hyponatraemia. Radiological examination revealed a sellar lesion and the tumour was removed via the transsphenoidal route. Thereafter, he simultaneously developed intractable diabetes insipidus and serious hyponatraemia with persistent natriuresis. ⋯ The oral administration of salt gradually improved his hyponatraemia as well as the coincident symptoms. By the administration of a mineralocorticoid, fludrocortisone acetate, we succeeded in maintaining his serum sodium level without salt replacement. We discuss the mechanism(s) and treatment of hyponatraemia associated with pituitary tumour.
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Acta neurochirurgica · Jan 1997
Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I: Anatomical and surgical considerations.
A unilateral laminotomy for bilateral access to the lumbar spinal canal was investigated in human cadaver spine specimens to test its practicability in the treatment of spinal stenosis. Micro-surgical decompression was performed by partial resection of the ipsilateral facet, the medial portion of the laminar arch, the contralateral facet and by complete removal of the ligamentum flavum. Anatomical, radiological and morphometrical studies on 4 adult cadaver spine specimens have proved the feasibility of this unilateral approach. Complete bilateral flavectomy and partial bilateral facetectomy were the essential surgical steps for an adequate operative decompression.