Neurosurgery
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We report a case of the anomalous exit of the C-6 nerve root at the C-6, C-7 foramen. This caused intense radicular and cervical pain in a 25-year-old woman. At myelography, the 5th and 6th cervical roots appeared conjoined, and at operation the C-6 root and ganglion were found to turn acutely downward, lateral to the pedicle of C-6, and then to exit with the C-7 nerve root through the C-6, C-7 foramen. ⋯ Cervical hemilaminectomy and resection of the pedicle of C-6 defined the anatomy and resulted in a clinical cure. The radiological features are described and contrasted with those of other anomalies. To our knowledge, this is the first report of such an anomalous course of exit of a cervical root.
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Visual loss due to optic nerve injury after closed head trauma constitutes a formidable diagnostic and therapeutic challenge for the clinician. Assessment must be made of the site of optic nerve injury, and this is often difficult in the patient with an altered level of consciousness. A decision regarding optic nerve decompression must be formulated, yet the literature is confusing with regard to operative indications. In reviewing current pathogenetic theories, clinicopathological data, and therapeutic options, this report attempts to clarify the role of surgical intervention in indirect optic nerve injury.