Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 2008
ReviewThe four medial ankle tunnels: a critical review of perceptions of tarsal tunnel syndrome and neuropathy.
The mechanisms of symptom production (other than a space-occupying lesion) and the diagnosis of tarsal tunnel syndrome remain controversial. To understand the diagnosis and treatment of tarsal tunnel syndrome in the presence of neuropathy, the known anatomy and pathophysiology related to the tarsal tunnel and the existing basic science and clinical evidence base related to these topics are reviewed. ⋯ For patients with tarsal tunnel syndrome and the comorbidity of diabetic polyneuropathy (DPN), it is concluded that a positive Tinel sign at the tarsal tunnel can predict a positive outcome for pain relief and restoration of sensation in 80% of the people who have decompression of the four medial ankle tunnels. With sensation improved, it is concluded that the natural history of DPN can be changed toward prevention of ulcers and amputation.
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Neurosurg. Clin. N. Am. · Apr 2008
Biography Historical Article Classical ArticleSurgical approaches and complications in the removal of vestibular schwannomas. 2007.
Vestibular schwannomas are benign tumors that usually originate from the balance portion of cranial nerve VIII. The treatment options currently available for vestibular schwannomas include observation with serial imaging, stereotactic radiation, and microsurgical removal. ⋯ Each approach has its advantages and disadvantages. The goal of surgery is complete eradication of tumor with preservation of hearing and facial nerve function when possible.
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Neurosurg. Clin. N. Am. · Apr 2008
Biography Historical Article Classical ArticleIntraoperative monitoring of facial and cochlear nerves during acoustic neuroma surgery. 1992.
Preservation of facial nerve function during acoustic neuroma surgery can be improved significantly by monitoring of facial electromyography (EMG) during surgery. Mechanical trauma during dissection causes EMG activity that can be played over a loudspeaker for direct feedback to the surgeon. Electrical stimulation can be used to locate the nerve even when it is out of direct view, and the threshold for stimulation provides a measure of facial (or other motor nerve) integrity. Cochlear nerve function also can be monitored by the recording of auditory brain stem responses or compound action potentials from an electrode placed on the nerve at the brain stem root entry zone.
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Chordomas are the most common primary malignant tumor of the mobile spine and of the sacrum. Although considered not to possess significant metastatic potential, such lesions are locally aggressive, leading to neurologic compromise and lytic destruction of bone. ⋯ Such radical resections may be associated with significant surgical morbidity, however. Although considered generally resistant to radiation therapy and chemotherapy, recent advances in photon and proton radiation therapy and use of monoclonal antibodies may provide improved outcomes for poor surgical candidates and for tumors that recur after surgery.
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This article reviews current published literature regarding pediatric iatrogenic spinal deformity, with particular emphasis on the cervical spine. The results of published series reporting the incidence, etiology, age, risk factors, surgical techniques, and treatment options are summarized. Iatrogenic deformity resulting from radiation therapy and a variety of surgical procedures are addressed.