Journal of neurosurgery
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Journal of neurosurgery · Mar 2004
Case ReportsSciatic nerve entrapment in the upper thigh caused by an injury sustained during World War II at the battle of Anzio. Case report.
The authors present an unusual case of sciatic nerve entrapment due to a World War II shrapnel injury to the left thigh suffered during the battle of Anzio in 1943. The patient presented for evaluation of left lower-extremity pain in the sciatic nerve distribution. Magnetic resonance imaging of the lumbosacral spine revealed a disc bulge at L5-S1 that would not explain severe sciatica. ⋯ The patient underwent exploratory external neurolysis of the area, and the sciatic nerve was released from fibrous adhesive entrapment. The patient improved dramatically following surgery. During a 3-year follow-up period, no recurrence of symptoms was noted.
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Vascular complications related to lumbar disc operations are rare but extremely fatal conditions. The authors analyzed data retrospectively obtained in 13 patients with vascular complications that occurred during lumbar disc operations performed between January 1990 and January 2002. ⋯ Despite its low incidence, iatrogenic vascular injury related to lumbar disc surgery is a possible complication. During lumbar disc operations early diagnosis of vascular injuries and urgent transperitoneal surgery can save patients' lives.
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Journal of neurosurgery · Mar 2004
Multimodality image-guided surgery for the treatment of medically refractory epilepsy.
The aim of this study was to review seizure outcome, imaging modalities used, and complications following surgery in patients with epilepsy who had undergone multimodality image-guided surgery at our institution. ⋯ Multimodality image-guided surgery offers a new perspective in surgery for epilepsy. Functional imaging modalities previously lateralized and often localized a seizure focus, but did not provide enough anatomical information to resect the epileptogenic zone confidently and safely. The coregistration of these modalities to a volumetric MR image and their incorporation into an image-guided system has allowed surgeons to offer surgery to patients who may not previously have been considered eligible, with outcomes comparable to those in patients with more straightforward lesional epilepsy.
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Journal of neurosurgery · Mar 2004
Surgical removal of corpus callosum infiltrated by low-grade glioma: functional outcome and oncological considerations.
Although still controversial, many authors currently advocate extensive resection in the treatment of low-grade gliomas (LGGs). Because these tumors usually migrate along white matter pathways, the corpus callosum is often invaded. Nevertheless, there is evidently no specific study featuring resection of the corpus callosum infiltrated by glioma, despite abundant literature concerning callosotomy in epilepsy surgery or transcallosal ventricular approaches. The aim of this paper was to analyze functional outcome following removal of corpus callosum invaded by LGG and to analyze the impact of this callosectomy on the quality of resection. ⋯ Resection of the corpus callosum infiltrated by glioma improves the quality of tumor removal without increasing the risk of sequelae.
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Journal of neurosurgery · Mar 2004
Preoperative neuroimaging findings as a predictor of the surgical plane of cleavage: prospective study of 100 consecutive cases of intracranial meningioma.
To understand the cause and prevention of postoperative ischemic and/or venous parenchymal infarcts after intracranial meningioma resection, the authors describe the value of neuroimaging in predicting the surgical plane of cleavage. ⋯ Peritumoral edema on preoperative CT and MR studies and tumor pial vascularization as seen on selective angiography can be used to predict the surgical plane of cleavage in meningiomas. The association between tumor size and a subpial surgical plane may be explained by a more pial vascularization seen on angiography. Meningiomas with a location in eloquent cortex and a subpial dissection plane should be considered a high-risk group.