British journal of neurosurgery
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We report an artefactual middle cerebral artery territory infarct on CT scan. This anomaly is suggested by the discrepancy between the clinical and radiological findings. Awareness of this possibility may avoid unnecessary further investigation or treatment.
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The objective of this investigation was to present the operative and hardware complications encountered during follow-up of patients with in situ deep brain stimulators. The study took the form of a retrospective chart review on a series of consecutive patients who were treated successfully with insertion of deep brain stimulators at a single centre by a single surgeon between 1999 and 2005. During the study period, a total of 60 patients underwent 96 procedures for implantation of unilateral or bilateral DBS electrodes. ⋯ We observed a higher proportion of early complications (<6 months postoperatively) in patients with Parkinson's disease, while dystonic patients had more late complications (>6 months postoperatively) and no early complications. Thirty per cent of our patients developed an adverse event that could potentially lead to revision of the implanted hardware. In patients with Parkinson's disease most of the complications tend to occur during the first 6 months postoperatively, while in dystonic patients most occur between 12 and 24 months postoperatively.
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Case Reports
Neurosurgical management of intracranial aneurysms following unsuccessful or incomplete endovascular therapy.
The publication of the ISAT trial in 2002 has resulted in increasing numbers of patients with aneurysmal subarachnoid haemorrhage undergoing endovascular coiling, as first line treatment for aneurysm occlusion. During the first 2-year period post-ISAT, in which all suitable intracranial aneurysms were coiled first, we had to perform surgery in seven patients out of 54 who underwent initial coiling. ⋯ We reviewed our surgical experience with the repair of these previously coiled aneurysms to identify unique technical difficulties. In particular, we found that an aneurysm height to neck ratio of less than 2:1 after coiling, and the use of stent-assisted coiling presented formidable challenges to direct clipping.
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Carotid-cavernous fistulas (CCF) are uncommon conditions, but cause significant morbidity if untreated. The majority of CCFs in young men are attributed to direct skull trauma. We present a case of CCF following a blunt injury to the neck.
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A case of growing skull fracture associated with unrecognized extradural haematoma is presented together with the relevant radiology. The pathophysiology of growing skull fracture is reviewed in light of this previously unreported case.