Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · May 2010
Case ReportsCordectomy as final treatment option for diffuse intramedullary malignant glioma using 5-ALA fluorescence-guided resection.
We present a case of an anaplastic astrocytoma (WHO-grade III, AA III) in a 27-year-old woman treated by spinal cordectomy. The patient was pretreated by surgery, radiation therapy and temozolomide chemotherapy and repeat surgery at recurrence. Later on, she developed paraplegia and a diffuse severe pain syndrome. MRI demonstrated intramedullar invasion from T12 to T9. To assess tumor invasion intraoperatively, we used tumor fluorescence derived from 5-aminolevulinic acid (5-ALA). ⋯ Our observation suggests 5-ALA fluorescence-guided resections to be useful in the context of malignant spinal cord gliomas. Furthermore, our particular case indicates that palliative spinal cordectomy with a wide margin and intraoperative resection using fluorescence guidance may be a final option for patients with recurrent spinal malignant glioma presenting with complete deficit below the lesion.
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Clin Neurol Neurosurg · May 2010
Case ReportsProspective collection and analysis of error data in a neurosurgical clinic.
It is still unknown how often surgical errors lead to clinical impact and contribute to complications for patients. Hence, reliable and detailed prospective collection and analysis of error data is considered essential and a valuable key to error prevention. ⋯ We were able to identify typical reoccurring deviations and discovered several procedure- and patient-related characteristics. Medical errors with relevant clinical impact were rare. Unexpectedly, the error rate in emergency cases was lower than in elective cases. Prospective error documentation and analysis are valuable, but also time-consuming since permanent close supervision is required for maintaining documentation quality.
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Clin Neurol Neurosurg · May 2010
Case ReportsBilateral diffuse intracerebral hemorrhagic infarction after cranioplasty with autologous bone graft.
We present the first case of a bilateral diffuse intracerebral hemorrhagic infarction following cranioplasty using an autologous bone graft. The case is that of a 63-year-old man who had undergone previous decompressive craniectomy due to right middle cerebral artery and posterior cerebral artery territory infarction. In order to avoid this extremely rare complication, the possible pathogenic mechanism underlying the deleterious cascade following cranioplasty is discussed.
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Clin Neurol Neurosurg · May 2010
Adverse effects of carbamazepine, phenytoin, valproate and lamotrigine monotherapy in epileptic adult Chinese patients.
Antiepileptic drugs (AEDs) have been widely used in patients with epilepsy but the adverse effects in adult Chinese patients have not been investigated. This study evaluated the adverse effects of four commonly prescribed AED monotherapies with carbamazepine (CBZ), phenytoin (PHT), valproate (VPA), and lamotrigine (LTG) in adult Chinese patients with epilepsy. ⋯ Adult Chinese patients with epilepsy accepted and tolerated monotherapy with CBZ, PHT, VPA, and LTG. No fatal adverse events occurred. Unsatisfactory seizure control was a primary reason for withdrawal from the AED monotherapy study.
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The primary treatment of meningiomas is surgery which can be curative if the tumor is completely removed. For parasagittal, lateral sphenoid wing and olfactory groove meningiomas, gross-total resection should be the goal. Tuberculum and diaphragma sella meningiomas can be resected through the subfrontal or the pterional approaches. ⋯ Stereotactic radiosurgery can be used as an alternative treatment to surgery either as a first-line treatment or at recurrence. Various conventional radiotherapy techniques can be employed for residual tumor post surgery or at recurrence. Chemotherapy has modest activity and is reserved for selected cases.