British journal of neurosurgery
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Although MRI is the imaging modality of choice for brain tumours, the standard clinical sequences cannot tell us about certain features of brain tumours. Improvements in imaging technology now allow advanced sequences, once used exclusively for research, to be used clinically. ⋯ These techniques can be used to improve identification of the tumour margin, tumour grading, reducing surgical risk and assessing the response to therapy. It is important for the neurosurgeon to understand what information can be obtained from these sequences, and that they ensure they are used to further develop the assessment and management of brain tumours.
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Case Reports
Surgical management for glossopharyngeal neuralgia associated with cardiac syncope: two case reports.
Two patients with glossopharyngeal neuralgia associated with cardiac syncope were treated with temporary cardiac pacemakers for cardiac syncope and then microvascular decompression. The offending arteries were the posterior inferior cerebellar artery in one patient and the anterior inferior cerebellar artery in the other. ⋯ After surgery, the patients were free from neuralgia and cardiac syncope did not occur after the pacemakers were extracted. Implantation of a temporary cardiac pacemaker in the perioperative period ensures safe microvascular decompression.
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Isolated sphenoid sinus infection, although an uncommon entity, can cause severe cranial complications when left untreated. A case of temporal epidural abscess secondary to isolated sphenoid sinusitis in a 13-year-old boy is presented. Early diagnosis and treatment are critical because the disease can progress rapidly.
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The purpose of this study was to report our experience with concomitant and adjuvant temozolomide (TMZ) with radiotherapy in patients with newly diagnosed glioblastoma multiforme (GBM). Forty-two newly diagnosed histopathologically proven patients with GBM underwent maximal safe resection followed by external radiotherapy to a total dose of 60 Gy in 30 fractions over 6 weeks along with concomitant oral TMZ (75 mg/m2) daily followed by adjuvant TMZ for 5 days every 28 days for six cycles (150 mg/m2 for the first cycle and 200 mg/m2 for rest of the cycles). Patients were monitored clinicoradiologically as per standard practice. ⋯ Treatment was generally well tolerated with 9% of patients developing grade 3 anaemia, 2% grade 3 leucopoenia, and 7% patients grade 3 or 4 thrombocytopenia respectively during the treatment. At last follow-up, among the surviving patients, 30% had a maintained KPS greater than 90%. Concomitant radiotherapy and TMZ followed by adjuvant TMZ prolongs survival in patients with glioblastoma multiforme and is well tolerated in our patient population.
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Decompressive craniectomy (DC) is considered a 'second tier' therapy to control posttraumatic intracranial hypertension refractory to maximal medical treatment. The authors present a case of refractory intracranial hypertension due to diffuse brain swelling and a large (>25 ml) non-surgically-treatable haematoma of the splenium of the corpus callosum successfully treated with bi-occipital DC and augmentative duraplasty.