Neurosurgery
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Review Case Reports
Primary isolated amyloidoma of the lumbar spine causing neurological compromise: case report and literature review.
We describe a patient with cauda equina compression secondary to amyloidoma to alert other clinicians to this rare cause of a compressive epidural lesion. It is the fourth published report of primary lumbar amyloidoma causing neurological compromise. ⋯ Lumbar epidural amyloidoma is an extremely rare cause of cauda equina compression. Clinical presentation can be nonspecific, and radiologically, it can be indistinguishable from a tumor. Diagnosis is made at histological examination of a Congo red-stained section under polarized light. Complete resection of the localized epidural amyloid mass is associated with a good prognosis.
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Arteriovenous malformations are a heterogeneous group of intra-axial central nervous system vascular lesions consisting of tangles of abnormal arteriovenous connections without intervening capillary beds. The heterogeneity of arteriovenous malformations is described by the Spetzler-Martin grading scale, a scale that also forms the basis for clinical decision making. The microsurgical treatment of appropriately selected supratentorial arteriovenous malformations is based on the tenets of circumferential isolation and transection of arterial feeders, preservation of vessels en passant and surrounding functional neural tissue, and skeletonization and transection of venous drainage.
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This report, with an accompanying videotape, details the authors' technique for performing radical resections of tumors intrinsic to the insular lobe. The resection technique takes advantage of the fact that many intrinsic insular tumors grow within the confines of the insula, usually without violating pial borders or invading the medial structures. The method described is based on an anatomic dissection of the insula that uses the internal boundaries of the region, particularly the peri-insular sulci, as guides for resection. The videotape provides a visual description of this method.
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Dexmedetomidine is a new intravenous drug gaining popularity in neuroanesthesia and neurocritical care practice. This alpha2-adrenergic receptor agonist offers a unique "cooperative sedation," anxiolysis, and analgesia with no respiratory depression. ⋯ In addition, sympatholytic and antinociceptive properties allow for hemodynamic stability at critical moments of neurosurgical stimulation. This review will address the neuropharmacology and neurophysiology of alpha2-adrenergic agonists and will specifically consider the rapidly evolving applicability of dexmedetomidine as an adjuvant to neurosurgical case management.
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Review Comparative Study
Risk of hemorrhage in hemangioblastomas of the central nervous system.
Hemangioblastomas are benign vascular tumors of the central nervous system. Several cases of spontaneous hemorrhage within these tumors have been reported. However, the risk of hemorrhage in these tumors remains unknown. ⋯ The overall incidence of hemorrhage in patients with hemangioblastoma is low. An important indicator for the probability of hemorrhage is tumor size, as spontaneous or postoperative hemorrhage occurred exclusively in extraordinarily large tumors. Hemangioblastomas smaller than 1.5 cm (the vast majority of these tumors) harbor virtually no risk of spontaneous hemorrhage.