Neurosurgery
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Review Case Reports
Complex cranial base trauma resulting from recreational fireworks injury: case reports and review of the literature.
Two patients who sustained complex skull base trauma secondary to recreational fireworks injuries are reported. Initial assessment and management included axial and coronal computerized tomography, control of hemorrhage, debridement of wound and brain, isolation of brain from external environment, and reconstruction of the cranial base floor. ⋯ In both patients, reconstruction of both the intracranial and extracranial compartments was successful with acceptable cosmetic result. Modification of multiple conventional approaches, along with a multispecialty surgical team, was used to deal effectively with these unique cases.
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Review Case Reports
Ruptured occult arteriovenous malformation associated with an unruptured intracranial aneurysm: report of three cases.
Three patients who were admitted for intracranial hemorrhage are reported. Cerebral angiography demonstrated an aneurysm arising from the middle cerebral artery bifurcation. No other malformation was visible either on the computed tomographic scan or on angiography. ⋯ Evacuation of the hematoma and thorough exploration of the cavity led to the discovery and resection of a small vascular anomaly typical of an arteriovenous malformation responsible for the hemorrhage. Occult vascular malformations and the association of aneurysm with arteriovenous malformations are discussed. In these 3 patients, the coexistence of these two malformations could be related to a common congenital abnormality.
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Review Case Reports
Pituitary tumors and aneurysms: case report and review of the literature.
A case of acromegaly from a growth hormone-secreting pituitary adenoma associated with dilatation of all major intracranial arteries and bilateral giant, cavernous aneurysms is presented. Although saccular aneurysms are randomly associated with all types of pituitary tumors, the frequency of this happening with growth hormone-secreting or "chromophobe adenomas" is greater than would be expected by chance alone. Intrasellar saccular aneurysms contiguous with tumors have been reported. ⋯ Anomalous large arteries, such as the trigeminal or transsellar-carotid variants, may run through the sella, and there is a case reported in which the former was associated with a pituitary tumor. A knowledge of these aneurysmal types and vascular anomalies is essential for the pituitary surgeon. Magnetic resonance imaging is now the radiological procedure of choice in the preoperative assessment of patients suspected of having pituitary tumors or recurrences, because, in addition to depicting the tumor, it defines the arterial anatomy and excludes all but very small coexistent aneurysms.
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Spinal cord astrocytomas are rare lesions, usually of low grade, with a long natural history. Because of this, it is difficult to define the optimum approach to therapy based on available data. To provide more data, a retrospective review was performed. ⋯ Of the 15 irradiated patients, 7 experienced recurrence of the tumor, which occurred within the irradiated portion of the spinal cord in all 7. Gross total resections were rarely achieved and, also, the extent of resection did not influence the risk for recurrence. In summary, we observed a long natural history for this disease, and although additional local therapy appears needed, it is unclear that either higher doses of radiation or more extensive surgery will decrease the risk of recurrence.