Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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While diffusion-weighted magnetic resonance imaging (MRI) has been used to study malignant brain tumours, this modality has not been used to study MRI abnormalities surrounding meningiomas. ⋯ The postoperative course of MRI abnormality surrounding tumour might be predictable from the intensity and ADC on preoperative DWI. Since MRI abnormalities associated with meningiomas can cause preoperative neurologic deficits. We hypothesise that abnormalities with restricted diffusion will be more likely to be associated with a preoperative deficit, and more likely to remain after removal of the causative meningioma.
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Neuronavigation is increasingly being used to assist in stereotactic neurosurgery due to its frameless property. In this study, we developed and assessed a modified method of performing stereotactic brain biopsies by combining the use of the Fisher stereotactic biopsy instrument, that was fixed on universal quick-lock holder, under infrared guidance of the BrainLab VectorVision Neuronavigation system. ⋯ All cases were on target and successful. In this paper, we present our technique, discuss the advantage and disadvantages of the method and review the literature.
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We describe our experience with Sophy programmable valve shunts, compared with Codman-Hakim programmable shunts in cases with normal pressure hydrocephalus (NPH) after subarachnoid hemorrhage (SAH). A total of 147 consecutive patients underwent 204 shunt implantations (102 Sophy valves, 51 Codman-Hakim valves, 51 nonprogrammable valves). Of these, 23 Sophy and 25 Codman-Hakim valves respectively were implanted into patients with NPH after SAH. ⋯ Total instances requiring shunt revision with Sophy valves in cases of NPH after SAH were 6 of 23 (26.1%), while for Codman-Hakim valves the figure was 2 of 25 (8.0%). Sophy, as well as Codman-Hakim programmable valve shunts, allow alteration of opening pressure after the implantation according to patients' conditions, which may contribute to reduction of revision. Similar reprogramming rates but lower frequency, and smaller difference between initial and final pressure in Codman-Hakim valves may be ascribed to finer pressure ranges and ease of reprogramming, which facilitates earlier reprogramming and decisions regarding final optimal opening pressure.
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Post-herpetic neuralgic affects up to 20% of patients after an attack of trigeminal Herpes Zoster infection. Past medical and surgical treatments have been unrewarding. We report the successful treatment of such a case with deep brain stimulation into the region of the contralateral periventricular grey area (PVG) and ventral posterior lateral thalamic nucleus (VPL).
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Case Reports
Tension pneumocephalus following transsphenoid surgery for pituitary adenoma - report of two cases.
Occurrence of symptomatic pneumocephalus following transsphenoid surgery is a rare event. Two cases of symptomatic pneumocephalus were observed in our series of 480 transsphenoidal surgeries. The first case reported presented with a head injury 4 years earlier and had a left frontotemporal haematoma evacuation. ⋯ He developed postoperative CSF rhinorrhea and in spite of conservative therapy, developed progressive visual deterioration necessitating a re-exploration and repair leading to resolution of the neurological deficits. The second case presented with delayed CSF rhinorrhea leading to rapid alteration in sensorium, requiring external ventricular drainage. The leak subsided without any further surgical intervention.