British journal of neurosurgery
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Case Reports
Contralateral acute interdural haematoma occurring after burr hole drainage of chronic subdural haematoma.
We report the case of a 78-year-old man with chronic subdural haematoma (CSDH) who presented with impairment in recent memory and gait disturbance. He underwent burr-hole craniostomy with a closed-drainage system. ⋯ The haematoma was located between the outer and inner dura mater that each comprise a single layer. To our knowledge, this is the first reported case of an acute haematoma located between the separated dura mater that occurred following drainage of a contralateral CSDH, and it is the second reported case of interdural haematoma over the cerebral convexity.
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Case Reports
Management of associated glioma and arteriovenous malformation--the priority is the glioma.
The conjunction of a glioma with an arteriovenous malformation (AVM) is exceptionally rare. We report the case of a malignant pleomorphic xanthoastrocytoma located on the vicinity of an untreated AVM that was removed without interference with the AVM. The question posed by such concurrent lesions is which to manage first. It appears more logical to treat the tumour first because of the elevated incidence of associated high-grade gliomas.
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Case Reports
Pin-site epidural hematoma in an adult case of chronic hydrocephalus with associated thinning of the cranium.
We report a case of a 22-year-old man presenting with a fourth ventricular tumour and associated chronic obstructive hydrocephalus likely leading to thinning of the cranium. Intraoperatively, he developed an epidural hematoma secondary to a fracture of the temporal bone by application of the three-point skull fixator. This is the second reported adult case of an iatrogenic epidural hematoma secondary to pin-site complications. We advocate the careful placement of the pins and suggest the tightening force be catered individually especially in pediatric patients or patients with chronic hydrocephalus.
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Randomized Controlled Trial Comparative Study
Comparison of unilateral pallidotomy and subthalamotomy findings in advanced idiopathic Parkinson's disease.
A prospective, randomized, double-blind pilot study to compare the results of stereotactic unilateral pallidotomy and subthalamotomy in advanced idiopathic Parkinson's disease (PD) refractory to medical treatment was designed. Ten consecutive patients (mean age, 58.4 +/- 6.8 years; 7 men, 3 women) with similar characteristics at the duration of disease (mean disease time, 8.4 +/- 3.5 years), disabling motor fluctuations (Hoehn & Yahr stage 3-5 in off-drug phases) and levodopa-induced dyskinesias were selected. All patients had bilateral symptoms and their levodopa equivalent dosing were analysed. ⋯ Cognitive functions were unchanged in both groups. Complications were observed in two patients: one had a left homonymous hemianopsia after pallidotomy and another one developed left hemiballistic movements 3 days after subthalamotomy which partly improved within 1 month with Valproate 1000 mg/day. The findings of this study suggest that lesions of the unilateral STN and GPi are equally effective treatment for patients with advanced PD refractory to medical treatment.