British journal of neurosurgery
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Review
Cerebral hyperperfusion syndrome after revascularization surgery in patients with moyamoya disease.
Moyamoya disease (MMD) is a progressive occlusive disease of the distal internal carotid artery that is primarily treated by superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Despite its effectiveness, several postoperative complications have been reported with STA-MCA bypass. Cerebral hyperperfusion syndrome (CHS) after STA-MCA has attracted considerable attention as a hemodynamics-related complication because more cases of CHS after STA-MCA bypass are reported in MMD than in non-MMD patients. ⋯ Imaging techniques, such as single photon emission computed tomography (SPECT), 3-T magnetic resonance imaging/angiography, and selective arterial spin-labeling magnetic resonance imaging, are valuable for identifying patients at risk for CHS. Treatment strategies include strict blood pressure control, intracranial hemorrhage prevention, and free oxygen radical scavenger administration. Most patients can achieve a satisfying prognosis after effective treatment.
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To compare the proportion of trauma craniotomies performed within 4 hours of presentation to emergency departments (ED) with and without on-site neurosurgery. ⋯ Forty-two per cent of trauma craniotomies are performed within 4 hours. However, presentation to an ED with on-site neurosurgical services significantly facilitates time critical surgery in children following a traumatic brain injury.
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In asleep-awake-asleep anaesthesia, removal and reinsertion of endotracheal tubes are associated with significant difficulty and risk. To overcome this, an oesophageal naso-pharyngeal catheter was developed. Its sealed distal end is placed in the oesophagus via the nose and the proximal end is connected to a ventilator or breathing circuit. ⋯ Ventilation occurs via the side holes on the tube located between the balloons and which sit over the laryngeal inlet. This eliminates the need to remove and reestablish airway devices with the associated risks. The authors report the preliminary experience using this device in 17 patients who underwent awake craniotomy for surgery adjacent to the 'eloquent' areas.
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Uncertainty remains as to the role of decompressive craniectomy (DC) for primary evacuation of acute subdural haematomas (ASDH). In 2011, a collaborative group was formed in the UK with the aim of answering the following question: "What is the clinical- and cost-effectiveness of decompressive craniectomy, in comparison with craniotomy for adult patients undergoing primary evacuation of an ASDH?" The proposed RESCUE-ASDH trial (Randomised Evaluation of Surgery with Craniectomy for patients Undergoing Evacuation of Acute Subdural Haematoma) is a multicentre, pragmatic, parallel group randomised trial of DC versus craniotomy for adult head-injured patients with an ASDH. In this study, we used an online questionnaire to assess the current practice patterns in the management of ASDH in the UK and the Republic of Ireland, and to gauge neurosurgical opinion regarding the proposed RESCUE-ASDH trial. ⋯ The survey results demonstrate that there is significant uncertainty as to the optimal surgical technique for primary evacuation of ASDH. The fact that the majority of the respondents are willing to become collaborators in the planned RESCUE-ASDH trial highlights the relevance of this important subject to the neurosurgical community in the UK and Ireland.
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Case Reports
Solitary neurolymphomatosis of the brachial plexus mimicking benign nerve sheath tumour: case report.
Neurolymphomatosis typically appears as a diffuse lesion with thickening of the affected nerves on magnetic resonance imaging (MRI). MRI in the present case revealed a well-defined, solitary lesion showing continuity with brachial plexus nerves. Findings including clinical symptoms resembled benign nerve sheath tumour rather than neurolymphomatosis. ⋯ The diagnosis of neurolymphomatosis was obtained only after resection biopsy. Post-operatively, (18)F-fluorodeoxyglucose positron emission tomography proved useful for follow-up evaluation. We offer the first description of the MRI characteristics of brachial plexopathy in neurolymphomatosis, along with the clinical course.