Neurosurgery
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Deep-seated supratentorial intraparenchymal and intraventricular brain lesions can be difficult to access without causing significant trauma to the overlying cortex and intervening white matter tracts. Traditional brain retractors use multiple blades, which do not exert pressure in an equally distributed fashion. Tubular retractors offer an advantage. Although a commercially available frame-based tubular retractor system is on the market (COMPASS; Compass, Inc., Rochester, MN), we modified existing off-the-shelf equipment at our institution into a frameless tubular brain retractor. ⋯ A frameless stereotactic tubular retractor system for deep brain lesions can be assembled with equipment already available at many institutions. Use of this system can decrease incision and craniotomy size, decrease retractor-induced trauma to overlying cortex, and help prevent damage to underlying white matter tracts.
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Case Reports
Neurophysiological intraoperative monitoring of the glossopharyngeal nerve: technical case report.
Neurophysiological intraoperative monitoring of the glossopharyngeal nerve has been performed only with needle electrodes inserted into the pharyngeal muscles or soft palate. We describe a noninvasive method of monitoring this cranial nerve. ⋯ Monitoring of the glossopharyngeal nerve with surface electrodes is possible and reliable, but it must be combined with vagus nerve monitoring.
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In this case report, we present a patient with normal pressure hydrocephalus in whom a lumbar drainage trial yielded a false-negative result secondary to cervical spondylosis. ⋯ This case report illustrates how altered cerebrospinal fluid flow dynamics may impact the accuracy of the lumbar spinal drainage trial in patients with normal pressure hydrocephalus.
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Case Reports
Surgical management of a paraclinoid aneurysm containing a displaced neuroform microstent: technical case report.
We report the first case of clip obliteration of a cerebral aneurysm containing a displaced microstent. ⋯ The patient experienced an excellent clinical and angiographic outcome. Although not the ideal treatment strategy, this report illustrates that clip obliteration of aneurysms containing displaced microstents can be performed successfully for this complication of endovascular treatment.
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The Chiari I malformation is a rare disorder characterized by downward herniation of the brainstem and cerebellar tonsils through the foramen magnum. Many individuals with the Chiari I malformation do not become symptomatic until adulthood, and the factors that contribute to the onset of symptoms have not been well characterized. The purpose of this systematic chart review was to determine the incidence and validity of minor head or neck trauma as precipitating factors for the onset of symptomatic Chiari I malformation. ⋯ Minor head or neck trauma can precipitate the onset of symptoms in a small number of previously asymptomatic patients with Chiari I malformation. Health care professionals must be aware that neurological symptoms that persist or worsen after minor head or neck trauma could indicate an underlying Chiari I malformation.