Journal of neurosurgery
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Journal of neurosurgery · Oct 2014
Outcome of modern shunt therapy in patients with idiopathic normal pressure hydrocephalus 6 years postoperatively.
Shunt therapy in idiopathic normal pressure hydrocephalus (iNPH) can improve symptoms in 84% of patients 1 year postoperatively. Therefore, implantation of a ventriculoperitoneal shunt (VPS) prevents or at least prolongs the time during which patients are not dependent on care from others because of gait disorder or dementia. In this study, the medium-term results of modern shunt therapy were evaluated. ⋯ Implantation of a VPS is a safe procedure and can improve symptoms in 74% of patients with iNPH in the longer term.
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Journal of neurosurgery · Oct 2014
Intracranial pressure following complete removal of a small demarcated brain tumor: a model for normal intracranial pressure in humans.
Current published normal values for intracranial pressure (ICP) are extrapolated from lumbar CSF pressure measurements and ICP measurements in patients treated for CSF pressure disorders. There is an emerging agreement that true normal ICP values are needed for diagnostic and therapeutic purposes. This study documents normal ICP in humans. ⋯ This study provides a preliminary reference range for normal ICP in humans. It is the first study to show that ICP in the healthy human brain decreases to negative values when assuming the upright position. If these results are later confirmed in a larger series, they might provide reference values for diagnosis and treatment in patients with CSF-related disorders. New normal values also have implications for future shunt design and the ICP target range in hydrocephalus treatment.
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Journal of neurosurgery · Oct 2014
Case ReportsAn isolated primary Rathke's cleft cyst in the cerebellopontine angle.
Rathke's cleft cysts (RCCs) are benign cysts typically located in the sellar or suprasellar region; ectopic isolated lesions are extremely rare. The authors describe the case of a 25-year-old man with a giant symptomatic RCC arising primarily at the cerebellopontine angle (CPA), only the second case reported thus far. The patient presented with a 2-year history of right hearing impairment and tinnitus accompanied by vertigo and headache and a 2-week history of right facial numbness. ⋯ Isolated ectopic RCCs can arise from the ectopic migration of Rathke's pouch cells during the embryonic period. It is still difficult to distinguish ectopic RCCs from other cystic lesions of the CPA given the lack of specific imaging features. Aggressive resection of the cyst wall is not recommended, except when lesions do not closely adhere to adjacent structures.
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Journal of neurosurgery · Oct 2014
Improvement in social function and health-related quality of life after shunt surgery for idiopathic normal-pressure hydrocephalus.
To investigate the impact of shunt surgery on the activity, participation, autonomy, and health-related quality of life (HRQOL) of patients with idiopathic normal-pressure hydrocephalus (iNPH) as well as the effect on caregiver burden. ⋯ After shunt surgery, patients with iNPH showed improvement in most aspects of social life, they became more independent, and their quality of life returned to nearly normal.
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Journal of neurosurgery · Oct 2014
Case ReportsVessel perforation during withdrawal of Trevo ProVue stent retriever during mechanical thrombectomy for acute ischemic stroke.
The authors report a case of an intracranial extravasation during the withdrawal of a Trevo ProVue stent retriever device in a patient being treated for acute ischemic stroke. An 82-year-old woman developed sudden left hemiparesis and aphasia during an urgent cardiac catheterization procedure for a non-ST elevation myocardial infarction. She had a baseline National Institutes of Health Stroke Scale (NIHSS) score of at least 10 and no improvement with intravenous administration of tissue plasminogen activator (tPA). ⋯ A unique and previously undescribed complication is vessel perforation during withdrawal of a stent retriever. Conservative treatment options and reversal of anticoagulation should be the first line of treatment for such complications. In the authors' case, performing the procedure without anesthesia was helpful in assessing the patient's neurological status.