Neurosurgery
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In this study of 72 patients who had histologically verified thalamic astrocytomas, 44 patients underwent stereotactic serial biopsy, 22 underwent stereotactic resection of the neoplasm, and an additional 6 patients underwent stereotactic biopsy followed by stereotactic resection of the tumor at a later date. Of the 50 patients who underwent stereotactic biopsy, 3 were neurologically worse after the procedure (morbidity, 6%), and 3 additional patients with Grade 4 astrocytomas who preoperatively were rapidly deteriorating neurologically, died within 30 days of the procedure. Of the 28 patients who underwent stereotactic resection, 14 were neurologically improved after the procedure, 10 were unchanged, and 4 were worse. ⋯ There was no neurological morbidity, but one patient died after resection. Many of those who underwent resection were deteriorating due to an enlarging tumor mass or recurring cyst, and had undergone more conservative therapies such as biopsy and radiation. Even though stereotactic biopsy is appropriate in many patients harboring thalamic astrocytomas, selected patients with significant mass effect from solid tumor or recurring cyst can benefit from stereotactic resection.
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We report the case of a young girl who suffered bilateral upper extremity paralysis after minor head trauma. Her clinical picture, as well as radiographic evidence of a fracture at C1, led to the diagnosis of Bell's cruciate paralysis, caused by a small lesion in the rostral part of the pyramidal decussation. Magnetic resonance images showed, in addition to a Chiari Type I malformation, an abnormality in the medulla. All previous cases of cruciate paralysis lack both pathological and radiographic supporting evidence.
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Case Reports
Paraparesis during myelography associated with a ruptured thoracic intervertebral disc.
Serious or permanent neurological complications following routine lumbar myelography are uncommon in clinical practice. We describe the sudden and dramatic onset of a symmetrical dense paraparesis in a patient after an uneventful lumbar puncture performed during myelography. A herniated thoracic intervertebral disc was subsequently diagnosed and successfully treated.
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A rare neurovascular complication of a antebrachial arteriovenous fistula in a chronic hemodialysis patient is reported. A large brachial venous pseudoaneurysm caused median neuralgia by direct compression of the nerve. Surgical resection of the pseudoaneurysm resulted in complete relief of neuralgia.