Neurosurgery
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Matrix detachable coils (MDC; Boston Scientific/Target, Fremont, CA) are platinum coils coated with a bioabsorbable polymeric material (polyglycolic-polylactic acid). In animal models, the introduction of polyglycolic-polylactic acid-coated coils into experimental aneurysms resulted in a cellular reaction which promoted stable intra-aneurysmal scar tissue formation. The current study was undertaken to assess the durability of aneurysm occlusion after embolization with MDC. ⋯ In the absence of Neuroform stent support, aneurysms embolized with the MDC system demonstrated a significant rate of recanalization. Many of the recanalizations were of sufficient size to warrant retreatment. The rates of recanalization observed in the present series were comparable to, or worse than, those reported for bare platinum coils.
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Neurofibromatosis 1 (NF1) is a common autosomal dominant disease characterized by complex and multicellular neurofibroma tumors. Significant advances have been made in the research of the cellular, genetic, and molecular biology of NF1. The NF1 gene was identified by positional cloning. ⋯ The Schwann cell was discovered to be the cell of origin for neurofibromas, but understanding of a more complicated interplay of multiple cell types in tumorigenesis, specifically recruited heterogeneous cell types such as mast cells and fibroblasts, has important implications for surgical therapy of these tumors. This review summarizes the most recent NF1 and neurofibroma literature describing the pathogenesis and treatment of nerve sheath tumors. Understanding the biological underpinnings of tumorigenesis in NF1 has implications for future surgical and medical management of neurofibromas.
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To assess the status quo of clinical management in patients with ruptured intracranial aneurysms in Germany. In addition to preferences in vascular treatment (i.e., surgical versus endovascular), the choice of diagnostics and treatment options in the pre- and postprocedural phase is emphasized. ⋯ In Germany, aneurysmal subarachnoid hemorrhage remains a disease in which standardization of clinical management is highest in preoperative diagnostics, intensive care unit monitoring, and postoperative treatment. With respect to currently published guidelines for subarachnoid hemorrhage treatment, compliance is moderate. Preferred treatment for anterior circulation aneurysms is predominantly surgical, whereas endovascular treatment options are preferentially used in aneurysms of the posterior circulation. This survey serves as a basis to analyze future developments in the management of subarachnoid hemorrhage more effectively and as an aid in finding a consensus in treatment both nationally and internationally.
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Traumatic leptomeningeal cysts represent a rare complication of a childhood cranial fracture, and occur in only 0.05 to 0.6% of all cranial fractures. In adults, clinical manifestations of a childhood trauma are very rare and usually appear in the form of nontender, nonpulsatile, subcutaneous mass, accompanied by a progressive neurological deficit and seizures, as shown in our case. ⋯ It is important to consider traumatic leptomeningeal cysts when treating adult patients with erosive bone lesions who have a history of head trauma.
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Medically intractable pain caused by occipital neuralgia (ON) can be very difficult to control with traditional pain management. Peripheral nerve stimulation (PNS) may serve as a good alternative to destructive surgical manipulations used currently for the treatment of severe ON. ⋯ Overall, the beneficial effect from chronic stimulation in our series persisted in more than half of the patients for whom procedure was considered and in 80% of those who significantly improved during the trial and proceeded with internalization. Thus, chronic PNS may be a safe and relatively effective method for long-term treatment of chronic pain syndrome in patients with medically intractable ON.