Neurosurgery
-
Epidural hematoma (EDH) of the spine represents an uncommon neurosurgical disorder that sometimes requires emergent surgical decompressive therapy. Traumatic EDH of the cervical spine is exceedingly rare. The hematoma is usually located dorsally in the epidural space. We present one case of acute EDH located ventrally in the cervical spine. Special emphasis is placed on the role of spinal endoscopy in surgical treatment. ⋯ Spinal endoscopy seems to be a useful tool in the surgical treatment of spinal EDH, providing control of the adjacent levels and allowing the limitation of the extent of bony resection.
-
To provide a theoretical basis for the selection of the anode-cathode configuration in spinal cord stimulation for the management pain when one percutaneous epidural electrode or two electrodes in parallel are used. ⋯ The relative positions of cathodes and anodes and their distance from the spinal cord are the major determinants of dorsal column/dorsal root activation and paresthesia distribution. The large interpatient variability of the intraspinal geometry is the main cause of differences in paresthesia coverage among patients having optimally placed electrode(s). Changes of paresthesia coverage over time are more probable when multiple electrodes are used.
-
Terson's syndrome (vitreous hemorrhage) and other ocular hemorrhages (retinal hemorrhages) have been reported to occur in up to 40% of patients with ruptured cerebral aneurysms. Because microsurgical vitrectomy can safely restore vision in patients with visual loss secondary to Terson's syndrome, we hypothesized that prospectively screening a selected group of patients with aneurysms would result in a higher rate of vitrectomy in patients with more extensive subarachnoid hemorrhage. ⋯ Ophthalmological screening of patients with histories of transient or prolonged comas after ruptured cerebral aneurysms very sensitively identifies patients with ocular hemorrhages, which are relatively common in patients with subarachnoid hemorrhage treated in an academic neurosurgical practice. The present study underestimates the true incidence of Terson's syndrome in that patients who died shortly after their subarachnoid hemorrhage were not included. Vitrectomy for patients who do not exhibit spontaneous improvement in vision results in a dramatic reversal of blindness.
-
Case Reports
Contralateral and ipsilateral microsurgical approaches to carotid-ophthalmic aneurysms.
The vicinity of carotid-ophthalmic aneurysms to the roof of the cavernous sinus, to the anterior clinoid process, and to the optic nerve or the optic chiasm requires well-defined surgical techniques. Although microsurgical techniques with ipsilateral direct approaches to these aneurysms have been described in detail, studies about contralateral strategies for the microsurgical treatment of carotid-ophthalmic aneurysms are rare and are mainly confined to case reports. The aim of this study is to describe how to decide on the ipsilateral and contralateral microsurgical approaches to such aneurysms and to demonstrate the surgical techniques for the ipsilateral and contralateral exposure of carotid-ophthalmic aneurysms. ⋯ Giant carotid-ophthalmic aneurysms that are eligible for surgical treatment as well as small and large aneurysms dislocating the optic nerve or the chiasm superomedially or medially should be approached via ipsilateral craniotomies. It is recommended that small and large aneurysms of the carotid-ophthalmic segment originating medially, superomedially, or superiorly, displacing the optic nerve or the chiasm superiorly, superolaterally, or laterally, be approached via contralateral craniotomies.
-
Case Reports Randomized Controlled Trial Clinical Trial
Relief of glossopharyngeal neuralgia by ketamine-induced N-methyl-aspartate receptor blockade.
We examined whether ketamine, which is a noncompetitive blocker of N-methyl-D-aspartate (NMDA) receptors, had the ability to relieve glossopharyngeal neuralgia. A tentative hypothesis is that glossopharyngeal neuralgia involves hyperactivity in the central nociceptive neurons and that the development of this hyperactivity is dependent on activation of NMDA receptors. ⋯ This case report shows that ketamine-induced NMDA receptor blockade significantly relieved glossopharyngeal neuralgia in this patient. Therefore, NMDA receptors may play a significant role in the pathogenesis of the pain syndrome described.