Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsGigantism treated by pure endoscopic endonasal approach in a case of McCune-Albright syndrome with sphenoid fibrous dysplasia: a case report.
McCune-Albright syndrome (MAS) is an uncommon polyostotic manifestation of fibrous dysplasia in association with at least one endocrinopathy that is mostly associated with precocious puberty and hyperpigmented skin macules named café-au-lait spots. We present an atypical manifestation of McCune-Albright syndrome in a 19-year-old man with the uncommon association of polyostotic fibrous dysplasia and gigantism in the absence of café-au-lait spots and precocious puberty. ⋯ Magnetic resonance imaging (MRI) found a right stalk shift of the pituitary with a 20 mm pituitary adenoma. We describe the diagnostic and endoscopic endonasal transsphenoidal approach for excision of the tumor.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsSimultaneous rupture of two middle cerebral artery aneurysms presented with two aneurysm-associated intracerebral hemorrhages.
Simultaneous rupture of more than one intracranial aneurysm is a rare event and difficult to diagnose. In this case report, we present the case of a patient with a simultaneous rupture of two middle cerebral artery (MCA) aneurysms with two separately localized aneurysm-associated intracerebral hemorrhages (ICH). Initially, the patient presented with headache and neck stiffness as well as progressive decrease of consciousness. ⋯ Rupture of both aneurysms was confirmed during surgery, and both aneurysms were clipped microsurgically without complications. Although rupture of one aneurysm in patients with multiple aneurysms is the most common event, this case indicates that simultaneous rupture should be kept in mind in patients with multiple aneurysms. In patients with multiple aneurysms, the identification of the ruptured aneurysm(s) is necessary to avoid leaving a ruptured aneurysm untreated.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsA variation of the cords of the brachial plexus on the right and a communication between the musculocutaneous and median nerves on the left upper limb: a unique case.
During routine anatomical dissection of the upper extremity of a 64-year-old cadaver for educational purposes, we observed variations in the brachial plexus on each side. On the right an anomaly of cord formation was present and on the left there was a communication between the musculocutaneous nerve (MCN) and median nerve (MN). On the right side the brachial plexus showed two trunks, superior (C5 and C6) and inferior (C7, C8, and T1); the middle trunk was absent. ⋯ This communicating branch also gave rise to a muscular branch to the brachialis muscle and the lateral cutaneous nerve of forearm. No additional heads of the biceps brachii muscle were observed in either upper limb. Knowledge of the variations of the brachial plexus in humans can be valuable for operations of the shoulder joint and its repair for providing an effective block or treatment for anesthetists and also for explaining otherwise incomprehensible clinical signs for neurologists.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsBilateral ptosis as initial presentation of gliomatosis cerebri: case report.
Gliomatosis cerebri is a rare, diffuse glioma of neuroepithelial origin involving more than two cerebral lobes. Clinical presentation of gliomatosis cerebri is variable and depends on the degree, extent, and location of cortical involvement. ⋯ Standard radiation and chemotherapy were administered but the patient eventually succumbed to the disease. The unique clinical presentation is discussed in light of this rare neoplasm of the central nervous system.
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J Neurol Surg A Cent Eur Neurosurg · Nov 2013
Lumbar ligamentum flavum: spatial relationships to surrounding anatomical structures and technical description of en bloc resection.
One structure, the ligamentum flavum, nearly always encountered in lumbar spinal operations, has not been examined as an important anatomical landmark. In this context, we describe its relevance in corridors of small surgical exposures created by minimally invasive spinal approaches. ⋯ Our cadaveric and microscopic surgical dissections show the ligamentum flavum as seen in the new corridors of small surgical exposures during minimally invasive surgeries of the lumbar spine. Identifying this landmark, surgeons can envision the location of the nerve roots to help prevent their injury.