Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Third ventricular tumors vary in etiology. Treatment and surgical approach usually depends on preoperative diagnosis. Colloid cysts are the most common tumors of the third ventricle and the occurrence of two colloid cysts in the ventricular system is rare. ⋯ This is the third reported patient with dual or paired colloid cysts. It is the second report of a lateral and third ventricular cyst, and to our knowledge the first to be successfully managed with purely endoscopic techniques obviating the need for a craniotomy. This report illustrates the importance of a wide differential when investigating intraventricular lesions and provides another example of a purely endoscopic transcortical approach for the resection of colloid cyst.
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Subarachnoid blood has been reported as a cause of chronic spinal arachnoiditis. Although syringomyelia has been thought to be caused by spinal arachnoiditis, reports of syringomyelia following aneurysmal subarachnoid hemorrhage (SAH) are very rare. We describe two patients with syringomyelia associated with chronic spinal arachnoiditis following SAH. ⋯ MRI revealed syringomyelia from the medulla oblongata to C6, and an enlargement of the lateral and fourth ventricles. After foramen magnum decompression and C1 laminectomy, a fourth ventricle-subarachnoid shunt was placed by insertion of a catheter. Spinal arachnoiditis and spinal syringomyelia are rare but important chronic complications after SAH.
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Percutaneous vertebroplasty (PVP) has played an increasing role in the treatment of osteoporotic compression fracture. The number of prior vertebral fractures and prior vertebroplasties are important risk factors for future fractures. We prospectively evaluated the effectiveness of teriparatide therapy for 28 patients who had repeated and multiple new-onset vertebral compression fractures (VCF). ⋯ Teriparatide therapy significantly decreased visual analogue scale pain scores, increased Japanese Orthopaedic Association function scores, increased spinal bone mineral density, and prevented new-onset VCF. Teriparatide can be used in patients who have repeated and multiple new-onset painful VCF to avoid repeated vertebroplasty. Therapy should continue for at least six months to ensure it is effective.
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Randomized Controlled Trial
Anesthetic and analgesic effects in patients undergoing a lumbar laminectomy of spinal, epidural or a combined spinal-epidural block with the addition of morphine.
This study was designed to evaluate the anesthetic, analgesic and side effects of spinal, epidural and combined spinal-epidural anesthesia with the addition of morphine for lumbar laminectomy. A total of 66 patients undergoing lumbar laminectomy were included in the present study of whom 64 completed the study. Patients were randomly divided into three groups: (i) spinal anesthesia - the SA group; (ii) epidural anesthesia - the EA group; and (iii) combined spinal-epidural anesthesia - the CA group. ⋯ The total consumption of morphine over the 24-hour study period was significantly higher in the SA group compared to the EA and the CA groups. Postoperative nausea and vomiting frequencies were higher in SA group, but pruritus frequency was lower than the EA and the CA groups. In conclusion, although spinal, epidural, and combined spinal-epidural anesthesia are adequate and effective for lumbar laminectomies, epidural and combined spinal-epidural anesthesia techniques are more effective than spinal anesthesia for postoperative analgesia and sedation with lesser side effects.
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Review Case Reports
Intracranial neuroenteric cysts: a concise review including an illustrative patient.
Neuroenteric cysts (NC) are rare, benign lesions lined by mucin-secreting cuboidal or columnar epithelium of an intestinal or respiratory type. They are regarded as ectopic endodermal cysts, and tend to be found in the spine rather than an intracranial location. Advances in neuroimaging have led to an increased frequency of diagnosis of NC, especially as an incidental finding, although such cysts may be confused radiologically with other lesions such as epidermoid and arachnoid cysts. ⋯ Only reports in English and those containing histopathologically-confirmed NC were considered for this review. In total, 140 patients with intracranial NC were found, including the patient reported in the present review. This review describes the classification, epidemiology, embryology, clinical presentation, radiology, histopathology, and surgical treatment of NC, and includes an illustrative patient.