Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Recurrent, irresectable meningioma constitutes an uncommon but significant problem. Many systemic therapies have been tested without clear evidence of efficacy. More recently, two reports have suggested that hydroxyurea has activity in this context. ⋯ Eleven patients achieved stable disease including eight patients who had documented progression prior to commencing hydroxyurea. These results are consistent with previous reports. In conclusion, hydroxyurea may provide some clinical benefit in patients with progressive meningioma by delaying progression of disease.
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The principles of management of civilian gunshot wounds (GSWs) to the head and spine have evolved directly from the experience gained in war by military neurosurgeons. The type of craniocerebral wounds being produced in urban gang warfare and suicide at tempts using handguns or rifles at close range vary considerably from the lower velocity fragment injuries which are common in modern warfare. Civilian craniocerebral GSWs are often devastating. ⋯ The indication for acute spinal cord decompression is deteriorating neurological status. Steroids are not indicated for these injuries. Neurosurgeons should take an active role in formulating and supporting public policy which aims to reduce possession and usage of firearms and therefore the prevalence of gunshot injuries.
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Summary Atlantoaxial subluxation is a rare complication of the upper neck inflammatory processes of head and neck region. Grisel's syndrome is a non-traumatic subluxation of the atlanto axial joint. It is not associated with trauma or bone disease. ⋯ Several theories have been proposed to explain the pathogenesis of inflammatory subluxation. The primary treatment of Grisel's syndrome is medical. We report a case of atlantoaxial rotatory subluxation treated with external fixation and antibiotic therapy.
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Sarcoidosis is a multisystemic disorder characterised by the presence of multiple noncaseating granulomas. Clinically recognisable nervous system involvement occurs in 5-16% of patients with sarcoidosis. ⋯ The following article presents a review of the disease, including its pathophysiology, clinical and radiological characteristics and treatment. Neurosarcoidosis should be included in the differential diagnosis of infectious and noninfectious neurological syndromes.
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Comparative Study
Burr-hole versus twist-drill drainage for the evacuation of chronic subdural haematoma: a comparison of clinical results.
Most neurosurgeons remove clinically symptomatic subdural haematomata, but the techniques they choose remain controversial. ⋯ The results at our institution indicate that burr-hole evacuation for chronic subdural haematoma is superior to twist-drill evacuation with respect to clinical outcomes and complications.