Neurosurgery
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Glossopharyngeal Neuralgia is an uncommon craniofacial pain syndrome that is occasionally associated with cardiac syncope. Involvement of the glossopharyngeal nerve may be painless or may be marked by true episodic neuralgia, and this justifies the term neuralgia reported here. We present 5 cases of this uncommon syndrome, of a total of 15 observed cases of glossopharyngeal neuralgia, successfully treated by section of the rootlets of Cranial Nerves IX and X or by microvascular decompression in the posterior cranial fossa. We also analyze the relevant literature and discuss the pathogenesis and treatment of the syndrome.
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Review Case Reports
Repair of temporosphenoidal encephalocele with a vascularized split calvarial cranioplasty: technical case report.
A 54-year-old woman was referred for the evaluation and treatment of spontaneous cerebrospinal fluid rhinorrhea. Magnetic resonance imaging revealed a right anteromedial intrasphenoidal encephalocele with cisternography showing the flow of contrast into the sphenoid encephalocele. Transcranial surgical repair was performed. ⋯ The technical details of this repair are discussed. Ten cases of temporosphenoidal encephaloceles have been reported. The literature concerning this rare form of encephalocele is reviewed.
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The resurgence of pulmonary tuberculosis in the United States has been paralleled by a concomitant rise in tuberculosis of the spine (Pott's disease). The appearance of drug-resistant strains of tuberculosis, infection in large numbers of immunocompromised hosts, newer imaging modalities, and the development of more effective spinal reconstruction techniques have raised important issues regarding the management of Pott's disease. In spite of this, there has been little published recently on the modern management of Pott's disease in developed countries. ⋯ Two patients have died; the remainder have been monitored for at least 1 year and are neurologically improved or normal without residual infection. The average angulation decreased from 31 to 24 degrees by the follow-up examination. In selected patients, early operative treatment with instrumentation, when indicated, minimizes neurological deterioration and spinal deformity, allows early ambulation, and results in excellent neurological outcome.
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Case Reports
Perioperative management and surgical outcome of the acromegalic patient with sleep apnea.
Sleep apnea is a rare complicating factor of acromegaly associated with a high risk of perioperative airway compromise and unclear response to transsphenoidal resection of the underlying pituitary tumor. We reviewed four acromegalic patients with sleep apnea and documented postoperative objective and subjective improvement of their sleep disorders. The pathogenesis of this disorder and safe perioperative airway management are discussed.
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Comparative Study
Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery.
Currently, microsurgical resection of acoustic neuromas by an experienced, multidisciplinary team is thought to be the treatment of choice. During the past 20 years stereotactic radiosurgery has been used as an alternative to surgical removal. To compare the results of both microsurgery and stereotactic radiosurgery, we conducted a study of 87 patients with unilateral, previously unoperated acoustic neuromas with an average diameter less than 3 cm treated by the neurosurgical service during 1990 and 1991. ⋯ Hospital length of stay and total management charges were less in the radiosurgical group (P < 0.001). When compared to microsurgical removal, stereotactic radiosurgery proved to be an effective and less costly management strategy of unilateral acoustic neuromas less than 3 cm in diameter. For many acoustic neuroma patients, stereotactic radiosurgery should be offered as an alternative management strategy.