Neurosurgery
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Case Reports
Surgery after radiosurgery for acoustic neuromas: surgical strategy and histological findings.
To retrospectively review the authors' experience with surgical resections after failed radiosurgery for acoustic neuromas. ⋯ Surgical resection after radiosurgery is indicated in the presence of such symptoms as cerebellar ataxia and increased intracranial pressure. It must be carefully considered because of the natural regression of transient tumor swelling over time. Surgical resection should be limited to subtotal removal for functional preservation. In patients with tumor enlargement several years after radiosurgery, the possibility of chronic intratumoral bleeding resulting from delayed radiation injury must be considered.
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In recent years, percutaneous laser disc decompression (PLDD) has become a routine surgical procedure because it can be performed under local anesthesia and is minimally invasive. However, there is a risk of nerve root and endplate injury owing to heat generated by laser irradiation during PLDD. We recently performed salvage surgery on a patient with heat injury to the L5 nerve root that developed after PLDD. ⋯ When salvage surgery is performed after a PLDD procedure, disc and nerve root injuries owing to laser heat energy must be considered.