Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Case Reports
Isolated thunderclap headache during sex: Orgasmic headache or reversible cerebral vasoconstriction syndrome?
Orgasmic headache (OH) is an "explosive" headache that occurs at orgasm. Historically, it was considered benign with no treatment needed. Reversible cerebral vasoconstriction syndrome (RCVS) refers to a group of disorders characterized by recurrent thunderclap headache (TCH) and multifocal vasoconstriction. ⋯ We concluded that she could be considered to have either OH or RCVS. This patient suggests the theory that OH could be a presentation of RCVS. Given that RCVS is potentially treatable, early recognition by clinicians is vital in order to prevent devastating complications.
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Multiple intracranial aneurysms located bilaterally in the anterior circulation are usually clipped sequentially by separate craniotomies or a bilateral craniotomy. However, in selected patients, bilateral aneurysms can be clipped on both sides in a single sitting through a unilateral approach and unilateral craniotomy without causing morbidity. We present our technique and results of bilateral aneurysms clipped through a unilateral craniotomy from the ruptured aneurysm side. ⋯ We therefore conclude that the unilateral orbito-pterional approach can be safely employed in selected patients harboring bilateral supratentorial saccular aneurysms and presenting with SAH, having WFNS grade 1 to 3, Fisher grade up to grade 3. The brain must be lax intra-operatively. Wide opening of the basal cisterns, 3rd ventriculostomy, and clipping of ruptured aneurysms are the important steps to be performed first before clipping the contralateral aneurysm thus avoiding a second craniotomy.
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Conjoined twins or Siamese twins are identical twins whose bodies are joined in the uterus. Craniopagus is a condition in which the heads of the two twins are joined. Craniopagus parasiticus is a rare condition in which one of the twins is rudimentary in form and parasitic on the other. Few cases of craniopagus parasiticus are reported in literature; here, we present one such rare occurrence.
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Meta Analysis Comparative Study
Hearing preservation rates after microsurgical resection of vestibular schwannoma.
Preservation of hearing is a major goal of surgery for patients with vestibular schwannoma (VS). We performed an analysis of the published literature on hearing outcome after microsurgery for VS. Our objective was to provide a comprehensive and unbiased description of published results. ⋯ Patients undergoing surgery via the MCF had better hearing outcomes on univariate analysis than those undergoing the RS approach (63% vs. 47%, p<0.0001). Multivariate analysis found that tumor size >1.5cm (odds ratio [OR] 2.81, 95% confidence interval [CI]=1.59-4.95, p<0.001), and the RS approach (OR 4.15, 95% CI=1.97-8.77, p<0.001) were independent significant risk factors for loss of serviceable hearing during VS surgery. Use of the MCF demonstrates superior hearing outcomes to the RS approach, even after correcting for the effect of the increased size of tumors addressed by the RS approach.
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Comparative Study
Sensitivity and specificity of in vivo diffusion-weighted MRI in acute spinal cord injury.
The aim of this study was to test the sensitivity and specificity of diffusion-weighted MRI for the detection of acute spinal cord injury. Forty female New Zealand white rabbits were randomly divided into four groups: the mild, moderate and severe injury groups, and the control (sham operation) group. Contusion of the spinal cord was induced using a weight-drop impactor. ⋯ The apparent diffusion coefficient values of the lesion were lower than those of adjacent unaffected regions in the mild and moderate injury groups, but higher than adjacent unaffected regions in the severe injury group. The histological findings were reliably correlated with the magnetic resonance findings. We found that DWI has a higher sensitivity, but a lower specificity, than conventional MRI for the detection of early pathological changes after contusive injury.