Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Authors have developed a simple, disposable instrument set for posterior cervical fusion (PCF). The instruments and technique minimize soft tissue disruption and facilitate access for cervical facet joint cartilage decortication. Technique is proposed for select patients not requiring laminectomy.
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Intracranial cerebrospinal fluid (CSF) hypotension usually arises in the context of known or suspected leak of CSF. This can be spontaneous, or due to central nervous system trauma or dural defects created during lumbar puncture or epidural anaesthesia. ⋯ Whilst commonly mild and self-limiting, CSF hypotension may result in life threatening complications and is most often treatable. When the syndrome is severe, prolonged or complicated, epidural blood patching (EBP) is the mainstay of treatment.
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Pneumorrachis (PR) is characterized by the presence of air within the spinal canal. It can be classified descriptively into internal or intradural and external or epidural. The causes of PR can be divided as iatrogenic, nontraumatic and traumatic. ⋯ It is a marker of severe injury and the majority of such patients have a poor outcome. Although, PR is usually asymptomatic and reabsorbs spontaneously, prompt recognition and management of the underlying cause is essential. Therefore, clinicians should maintain a high level of suspicion for serious underlying injury in cases where initial radiological imaging reveals intraspinal air.
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Predictors of aggressive clinical phenotype among immunohistochemically confirmed atypical adenomas.
Despite formal pathological criteria, not all atypical pituitary adenomas display clinically aggressive behavior. We set out to determine which factors predict a clinically aggressive phenotype among a cohort of atypical pituitary adenomas. Medical records were retrospectively reviewed from April 2008 to July 2015. ⋯ Clinically aggressive lesions, however, trended towards a greater average MIB-1 proliferative index (7.5%±4.9 vs. 6.0%±3.6, p=0.03). On multivariate analysis, the MIB-1 proliferative index trended towards statistical significance (p=0.06) as an independent predictor of clinical aggressiveness. Atypical pituitary adenomas are defined by a rigid set of immunohistochemical markers, but not all necessarily demonstrate an aggressive clinical phenotype.
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The authors retrospectively analyzed cyst formations and expanding haematomas (EHs) that developed after Gamma Knife surgery (GKS) for arteriovenous malformations (AVMs), and evaluated the treatment results of these lesions. Cyst formations and/or EHs which developed after GKS for AVMs were identified in 20 patients (5.0%) out of 404 patients who underwent this procedure. There were nine patients with cyst formations, two with EHs and nine with cyst formations with EHs. ⋯ There was no recurrence of the lesions in all the patients that underwent a craniotomy. In the patient treated with a cyst aspiration, regrowth of the cyst formation occurred. Surgical treatment should be considered for symptomatic lesions and we recommend total removal of the angiomatous lesions to achieve a complete cure.