Neurosurgery
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Chiari I malformation occurs because of an underdeveloped posterior fossa with reduced volume that cannot accommodate the normally developed hindbrain. ⋯ More than half the pediatric patients with Chiari I malformation improve after surgery. The age at presentation, duration and type of symptoms, cranial and foramen magnum morphometry, and syrinx-related changes have no bearing on outcome at short-term follow-up. The spinal cord diameter differs significantly in patients with and without functional improvement.
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Studies attempting to establish the safety and efficacy of standard and high-dose intra-arterial infusions of calcium channel blockers for treatment of cerebral vasospasm have focused on hemodynamic changes during the angiographic procedure. ⋯ High-dose intra-arterial verapamil causes increases in ICP and reductions in CPP, followed by an increase in brain glucose levels, without altering brain oxygen tension or oxidative metabolism. Patients undergoing high-dose intra-arterial verapamil therapy warrant close hemodynamic and ICP monitoring for at least 12 hours following treatment.
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Galenic dural arteriovenous fistulas (DAVFs) are a subtype of the rare falcotentorial DAVFs with a high risk of hemorrhage and an aggressive clinical course. Microsurgical treatment is often necessary because endovascular obliteration will rarely completely obliterate the DAVF. ⋯ Direct interruption of the fistula key point by clipping of the venous aneurysm, rather than interruption of the feeding vessels, was mandatory for complete exclusion of this complex galenic DAVF.