Neurosurgery
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To evaluate clinical usefulness of cerebrospinal fluid stroke volume (SV) assessed in the cerebral aqueduct, via cine phase-contrast magnetic resonance imaging, for predicting outcome after shunt surgery in suspected normal pressure hydrocephalus. ⋯ The data from this study show no evidence that cine phase-contrast magnetic resonance imaging measurements of SV in the cerebral aqueduct are useful for selecting patients with normal pressure hydrocephalus symptoms to shunt surgery.
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The widespread use of the endoscope in transsphenoidal pituitary surgery has recently contributed to the extension of the approach beyond the tuberculum sellae and planum sphenoidale for the management of lesions located in the suprasellar area, either with an endoscope-assisted or purely endoscopic technique. Based on our previous experience with more than 450 standard endoscopic transsphenoidal operations, we have retrospectively evaluated the effectiveness of the extended endoscopic endonasal transsphenoidal approach in the management of lesions mainly located in the suprasellar area. ⋯ Small and medium sized suprasellar lesions located in the midline, with or without a limited parasellar extension and without involvement of vascular structures, seem amenable to be resected through such extended endoscopic transsphenoidal approach. Improvements in closure techniques and the use of new materials and surgical glues seem to significantly reduce the postoperative cerebrospinal fluid leak rate and meningitis.
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Phenytoin (PHT) is widely administered after subarachnoid hemorrhage, often for several weeks or months. In addition to known side effects, PHT use has been correlated with cognitive disability and poor outcome. To reduce the rate of PHT complications, we converted from a multi-week prophylactic regimen to a 3-day course of treatment. This study evaluates the changes in seizure rates and adverse events. ⋯ A 3-day regimen of PHT prophylaxis is adequate to prevent seizures in subarachnoid hemorrhage patients. Drug reactions are significantly reduced, but seizure rates do not change. Short-term PHT administration may be a superior treatment paradigm.
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Degenerative disease of the cervical spine commonly occurs in the natural process of aging. This can lead to compression of the spinal cord and symptomatic myelopathy. We review the pathophysiological factors that lead to myelopathy and the controversial natural history of untreated myelopathy. Signs and symptoms at presentation, examination findings, differential diagnosis, and diagnostic studies are also discussed.
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Case Reports
Spinal cord herniation into associated pseudomeningocele after brachial plexus avulsion injury: case report.
Posttraumatic spinal cord herniation is a rare condition. We describe a case of spinal cord herniation into an associated pseudomeningocele after a brachial plexus avulsion injury. ⋯ Brachial plexus root avulsions may result in the formation of pseudomeningoceles and can lead to spinal cord herniation. Coronal magnetic resonance imaging is useful to demonstrate spinal cord herniation as well as pseudomeningoceles. Surgical treatment is recommended for such cases with progressive symptoms to prevent further deterioration.