Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Mar 2014
Open thoracic cordotomy as a treatment option for severe, debilitating pain.
The treatment of patients with debilitating lower extremity or medically refractory quadrant pain presents a challenge for management. Contemporary neuromodulatory therapies may not be affordable or practical, especially in patients with limited life expectancy or from countries with limited resources. We present a small retrospective series to evaluate the role of open thoracic cordotomy as a practice option in the treatment of patients with severe, unilateral, medically refractory pain of the lower abdominal quadrant, hip, or leg. Technical aspects of the procedure, anatomic pathways within the spinal cord, and intraoperative maneuvers are described. ⋯ Although open thoracic cordotomy may be cautiously recommended as a treatment option in certain settings, this procedure should be viewed only as a second-line treatment option in settings where the technology and expertise to perform PCC are available.
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J Neurol Surg A Cent Eur Neurosurg · Jan 2014
Case ReportsHemostasis management during completely endoscopic removal of a highly vascular intraparenchymal brain tumor: technique assessment.
Recently, stereotactic-guided removal of intraparenchymal lesions using endoscopic visualization through a brain port has been successfully reported. Although endoneurosurgical tumor resection uses the same principles as those used in microneurosurgery, the ability to control bleeding through the port requires an adapted technique. ⋯ Removal of vascular tumors is feasible through the brain port, despite a relatively narrow corridor of 11.5 mm. However, specific hemostasis techniques are required and adapted instruments are needed to ensure hemostasis through these small corridors.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsAcute onset of hemiparesis after gamma knife radiosurgery for arteriovenous malformation caused by hyperacute thrombosis of draining vein: a case report.
Complications after gamma knife radiosurgery (GKRS) have been attributed most commonly to radiation-induced damage to the brain. Early occlusion of the draining veins has been postulated as one of the rare causes of complications after GKRS, which often occurs at or beyond 6 months after GKRS. ⋯ Early draining vein occlusion is an important cause of postradiosurgery complications, and it can rarely occur within days.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsPial arteriovenous fistula as a cause of bilateral thalamic hyperintensities--an unusual case report and review of the literature.
Isolated bilateral thalamic congestion due to an arteriovenous malformation (AVM) is a rare entity. Few case reports of dural arteriovenous fistula associated with it have been reported in the literature. The association of pial arteriovenous fistula (pial AVF) with thalamic hyperintensities has never been described before. The pial AVF is a recently recognized lesion in which the multiple pial arterial feeders drain into a single venous channel without a nidus like in conventional AVM. In spite of being congenital in origin, these lesions may have expression in adulthood due to abrupt change in the venous drainage system. Successful management of pial AVF associated with bilateral thalamic hyperintensities is described here with review of the literature. ⋯ Strong suspicion of vascular malformation as a cause of bilateral thalamic hyperintensities helps in early detection. Such lesions like pial AVF presented here require active intervention by surgery or endovascular therapy. GKT is an important adjuvant in lesions refractory to either of them.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsIs it safe to sacrifice the superior hypophyseal artery in aneurysm clipping? A report of two cases.
Clipping of paraclinoid internal carotid artery aneurysms related to the superior hypophyseal artery (SHA) carries risk of occlusion of this artery when originating distal to the neck of the aneurysm. Sometimes it is inevitable to sacrifice the artery to achieve total aneurysm occlusion. Otherwise a residual aneurysm would remain, which may lead to aneurysm regrowth and subsequent rupture. ⋯ Intraoperative ICG angiography may help to estimate collateral blood flow but is not able to predict visual decline. Although final conclusions cannot be drawn from two patients, it seems that in case of multiplicity of superior hypophyseal complex, sacrifice of one even larger branch is safe. However, visual sequelae have to be taken into consideration when a single SHA has to be sacrificed for total aneurysm clipping.