Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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We aimed to evaluate the clinical utility and safety of the hook and rod method for occipitocervical fusion. Eleven consecutive patients (3 males, 8 females; 50-78 years old, average 63.8 years; 16-77 months follow-up, average 33.7 months) with unstable lesions at the craniocervical junction who underwent occipitocervical fusion using a hook and rod system were examined. A Compact Cotrel-Dubousset cervical system (Sofamor-Danek, Memphis TN, USA) was used in all patients. ⋯ No complications occurred during surgery. Solid bony fusion was obtained in all patients and no patient became clinically worse postoperatively. Occipitocervical fusion using a hook and rod system is a useful procedure that allows decompression of the spinal cord and secure spinal fusion at multiple levels simultaneously.
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Cluster headache is a severely debilitating disorder that can remain unrelieved by current pharmacotherapy. Alongside ablative neurosurgical procedures, neuromodulatory treatments of deep brain stimulation (DBS) and occipital nerve simulation have emerged in the last few years as effective treatments for medically refractory cluster headaches. ⋯ Controversy remains over which surgical treatments are best and in which circumstances to intervene. Here we review current data on neurosurgical interventions for chronic cluster headache focusing upon DBS and occipital nerve stimulation, and discuss the indications for and putative mechanisms of DBS including translational insights from functional neuroimaging, diffusion weighted tractography, magnetoencephalography and invasive neurophysiology.
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Neurocysticercosis (NCC) is an infection of the brain and its coverings by the larval stage of the tapeworm Taenia solium. It is the most common helminthic infestation of the central nervous system and a leading cause of acquired epilepsy worldwide. NCC induces neurological syndromes that vary from an asymptomatic infection to sudden death. ⋯ The selection of cases for medical or surgical treatments has improved and these two forms of therapy are complementary. In general, indications of surgery are: cysts that compress the brain and cranial nerves locally, intracranial hypertension or edema refractory to medical treatment, intraventricular NCC, spinal NCC with cord or root compression and ocular cysts. Recently, endoscopic approaches for ventricular NCC have been developed, which are now the treatment of choice for ventricular NCC with hydrocephalus.
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Although many scales attempt to predict outcome following aneurysmal subarachnoid hemorrhage (aSAH), none have achieved universal acceptance, and most scales in common use are not statistically derived. We propose a statistically validated scale for poor grade aSAH patients that combines the Hunt and Hess grades and the Glasgow Coma Scale (GCS) scores; we refer to this as the Poor Grade GCS (PGS). The GCS scores of 160 poor grade aSAH patients (Hunt and Hess Grades 4 and 5) were recorded throughout their hospital stay. ⋯ No patients with a PGS-C or PGS-D over the age of 70 had a favorable long-term outcome. Therefore, elements of the Hunt and Hess and GCS can be combined into the PGS to predict long-term outcome in poor grade aSAH patients. However, patients with PGS-C and PGS-D over the age of 70 should be assessed carefully prior to definitive treatment.
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Case Reports
Use of spontaneous ventilation to monitor the effects of posterior fossa surgery in the sitting position.
We describe the successful excision, guided by spontaneous ventilation, of a cervico-medullary hemangioblastoma in a 22-year-old female in the sitting position. A balanced anesthesia technique comprising an oxygen, nitrous oxide, sevoflurane, fentanyl and vecuronium mixture was used. ⋯ The intraoperative and postoperative course were uneventful. The patient recovered without any major neurological deficit.