Journal of neurosurgery
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Journal of neurosurgery · Jan 2002
Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures.
The use of polymethylmethacrylate (PMMA) cement by percutaneous injection in cases requiring vertebroplasty provides pain relief in the treatment of osteoporotic vertebral compression fractures. A retrospective study was performed to assess what caused PMMA cement to leak into the epidural space and to determine if this leakage caused any changes in its therapeutic benefits. ⋯ The authors found that epidural leakage of PMMA after percutaneous vertebroplasty was dose dependent. The larger amount of injected PMMA, the higher the incidence of leakage. Injecting vertebral levels above T-7 also increased the incidence of epidural leakage. Epidural leakage of PMMA may attenuate only the immediate therapeutic effects of vertebroplasty.
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Journal of neurosurgery · Jan 2002
Case ReportsCervicomedullary junction compression caused by vertebral artery dolichoectasia and requiring surgical treatment. Case report.
A case of progressive brainstem syndrome secondary to vertebral artery (VA) dolichoectasia is reported. The patient presented with partial bilateral abduction paralysis, which progressed to quadriparesis, ataxia, and areflexia. The initial diagnosis was stroke, but because of the patient's deterioration, a diagnosis of Miller-Fisher syndrome was made. ⋯ Follow-up imaging demonstrated worsened cervicomedullary compression. An emergency posterior fossa neurovascular decompression was performed using a Gore-Tex sling and resulted in mild neurological improvement. This case emphasizes that early recognition and surgical intervention to prevent progressive neurological sequelae are crucial in symptomatic VA dolichoectasia.
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Journal of neurosurgery · Jan 2002
Interactive stereoscopic virtual reality: a new tool for neurosurgical education. Technical note.
The goal of this study was to develop a new method for neurosurgical education based on interactive stereoscopic virtual reality (ISVR). Interactive stereoscopic virtual reality can be used to recreate the three-dimensional (3D) experience of neurosurgical approaches much more realistically than standard educational methods. The demonstration of complex 3D relationships is unrivaled and easily combined with interactive learning and multimedia capabilities. ⋯ The success of a neurosurgical approach is contingent on the mastery of complex, 3D anatomy. A new technology for neurosurgical education, ISVR can improve understanding and speed the learning process. It is an effective tool for neurosurgical education, bridging the substantial gap between textbooks and intraoperative training.
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Journal of neurosurgery · Jan 2002
Acute traumatic central cord syndrome: magnetic resonance imaging and clinical observations.
Acute traumatic central cord syndrome has been classically thought to be caused by a hemorrhage that primarily affects the central part of the spinal cord and that destroys the axons of the inner part of the corticospinal tract devoted to the motor control of the hands. Some authors, however, have proposed that its pathogenesis is based on the destruction of the motor neurons supplying the muscles of the hand. To test the validity of these two theories, the authors retrospectively studied the magnetic resonance (MR) images obtained in 18 cases of acute traumatic central cord syndrome (ATCCS) to assess the presence of intramedullary blood and to define the distribution of the abnormal signal intensities in the cervical spinal cord. ⋯ Acute traumatic central cord syndrome cannot be explained by the injury to the gray matter at the level of motor neurons supplying the hand muscles. In agreement with recently published data, the results of this series confirm the absence of intramedullary hemorrhage and corroborate the hypothesis that ATCCS may be explained by the impairment of the corticospinal tract, which can be affected globally.
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Journal of neurosurgery · Jan 2002
A proposed radiosurgery-based grading system for arteriovenous malformations.
Radiosurgery is an effective treatment strategy for properly selected patients harboring arteriovenous malformations (AVMs). Grading scales that are currently used to predict patient outcomes after AVM resection are unreliable tools for the prediction of the results of AVM radiosurgery. ⋯ Despite significant differences in preoperative patient characteristics and dose prescription guidelines at the two centers, the proposed AVM grading system strongly correlated with patient outcomes after single-session radiosurgery for both patient groups. Although further testing of this model by independent centers using prospective methodology is still required, this system allows a more accurate prediction of outcomes from radiosurgery to guide choices between surgical and radiosurgical management for individual patients with AVMs.