Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
-
The sitting position offers many advantages in terms of surgical access for posterior fossa and posterior cervical spine surgery. However, these advantages must be balanced against the risks which include venous and paradoxical arterial air embolism, cerebral and myocardial ischaemia secondary to hypotension, and complications of the positioning itself. These are largely in the domain of the neuroanaesthetist. In this paper, therefore, we will review the advantages, disadvantages and management of complications of the sitting position, from the neuroanaesthetist's perspective.
-
We evaluated the usefulness of adjuvant treatment with gamma knife radiosurgery following meningioma surgery. During the past 8 years, we operated on 78 patients with meningiomas. Among these, 28 patients (36%) received gamma knife radiosurgery postoperatively. ⋯ No radiation injury was experienced. Adjuvant therapy using gamma knife radiosurgery for meningiomas can achieve control of tumour growth and may improve patient outcomes. Careful surgical planning and follow-up are required to understand the usefulness and limitations of radiosurgery in this setting.
-
A 42-year-old female presented with typical glossopharyngeal neuralgia. Magnetic resonance imaging demonstrated an epidermoid tumour in the left cerebellopontine angle. ⋯ The tumour was subtotally removed and after surgery the patient showed a complete relief of pain. This is a very rare case of glossopharyngeal neuralgia alone due to an epidermoid tumour.
-
Background. We have previously described the resection of hypothalamic hamartomas (HH) using a transcallosal approach [Transcallosal resection of hypothalamic hamartomas, with control of seizures, in children with gelastic epilepsy, Neurosurgery, 2001]. Since then, we have refined the technique and now describe in detail an anterior transcallosal transseptal interforniceal approach to the third ventricle as a variation of the standard transcallosal interforniceal approach. ⋯ Conclusion. The anterior transcallosal transseptal interforniceal technique is an effective and relatively safe technique when used for the resection of HH. This operative approach is applicable to other pathology in the third ventricle or hypothalamic region and has advantages compared with the standard transcallosal approach to the third ventricle.
-
The correlation of coagulopathy and pupillary light reflex, the degree of midline shift in brain computer tomography and Glasgow outcome scale (GOS) after head injury were prospectively evaluated. From September 2002 to March 2003, 61 patients (45 males and 16 females; mean age: 41.9 years) after head injury were enrolled in the study. A modified coagulopathy score (CS) defined by prothrombin time, partial thromboplastin time, platelet count, D-dimer and fibrinogen was calculated for each patient within 24 h after injury. ⋯ Our results showed pupillary light reflex has the most significant correlation to GOS (rho = 0.727, p < 0.0001). It also reveals that coagulopathy score > or 4 (positive predictive value 90%) may have higher degree of accuracy to predict mortality comparing to both pupils being fixed or brain CT midline shift > or = 15 mm. We conclude that: (1) Coagulation state in head injury patients within 24 h after injury is of value in determining the outcome. (2) Coagulopathy score > or = 4 is a good predictor to evaluate mortality rate of head injury patients.