Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
-
Case Reports
Global aphasia without hemiparesis may be caused by blunt head trauma: An adolescent boy with transient aphasia.
Global aphasia without hemiparesis is a rare condition often associated with embolic stroke. Posttraumatic causes have not been reported, in the literature, to our knowledge. ⋯ In our case, clinical findings occurred 1week later following head trauma. Emergence of the symptoms after a period of the first mechanical head trauma, draws attention to the importance of secondary process in traumatic brain injury.
-
Management of the airway may be challenging in patients undergoing occipito-cervical spine fusions (OCF). Changes in the occipito-cervical angle (dOC2A) of fusion after surgery may result in acute airway obstruction, dyspnea and/or dysphagia. Objectives of the study were to review the airway management of patients during posterior OCF, determine the incidence, nature and risk factors for postoperative airway adverse events (AEs), and to determine the relationship between airway AEs and the change in dOC2A. ⋯ Factors such as difficult intubation, number of vertebral levels fused and duration of surgery have to be considered. A significant correlation between dOC2A and postoperative AEs could not be established. Risk factors for postoperative AEs are multifactorial and prospective evaluation of these factors is indicated.
-
Whether surgery improves the outcome more than medical management alone continues to be a subject of intense debate and controversy. However, there is optimism that the management of spontaneous supratentorial intracerebral haemorrhage will change in future based new insight and better understanding of the acute pathophysiology of hematomas and its dynamics. Craniotomy as a surgical approach has been the most studied intervention for spontaneous supratentorial intracerebral haemorrhage but with no significant benefit when compared to best medical management. ⋯ The role of surgery in the management of spontaneous intracerebral haemorrhage still remains a matter of debate. There is insufficient evidence to justify a general policy of early surgery for patients with spontaneous intracerebral haemorrhage compared to initial medical management but STICH did demonstrate that patients with superficial hematoma might benefit from craniotomy.
-
Blister aneurysms at non-branching sites of the dorsal internal carotid artery (dICA) are fragile, rare, and often difficult to treat. The purpose of this study is to address the demographics, treatment modalities, and long-term outcome of patients treated for dICA blister aneurysms. A retrospective review of medical records identified all consecutive patients who presented with a blister aneurysm from 2002 to 2011 at our institution. ⋯ There was no detected significant difference between microsurgical clip ligation and endovascular coil embolization in terms of surgical outcome. These blister aneurysms demonstrate a propensity to be associated with multiple cerebral aneurysms. Strict clinical and angiographic long-term follow-up may be warranted.
-
Lumbar total disc replacement (TDR) is an alternative to interbody fusion for the treatment of symptomatic degenerative disc disease. Traditionally, lumbar TDR is performed via an anterior retroperitoneal approach with regional risks of vascular and visceral injury. The direct lateral retroperitoneal, transpsoas approach avoids mobilisation of the great vessels and preserves the anterior longitudinal ligament, thereby maintaining physiological limits on motion. ⋯ Lumbar TDR using the XL-TDR via a lateral transpsoas muscle-splitting approach is a minimally invasive alternative to anterior retroperitoneal exposures for motion preservation. Correct sizing of the XL-TDR and complete contralateral annulectomy with annulus box cutters mitigates the risk of lateral dislocation. Revision surgery for lateral dislocation of the XL-TDR is more straightforward compared to anterior TDR dislocation.