J Neurosurg Sci
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The evident rise in the number of neurosurgical malpractice and the apparent lack of adequate training in neurosurgery patient management are discussed. However, alongside neurosurgeons, neurosurgical malpractice claims involve also physicians from primary to specialist care, particularly those attending neurosurgical patients in emergency rooms. Some pathologies and disputed treatments are described. ⋯ On the basis of personal experience, some considerations and recommendations are suggested for the clinical practice.
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Case Reports
Reconstruction of a large post-traumatic cranial defect with a customized titanium plaque.
The treatment of serious cranial defects has always been a fascinating and controversial issue for craniofacial surgeons and in the last years many solutions have been proposed. One of the most effective method is a personalized titanium plaque prepared by processing anatomical data obtained with a CAT of the patient. A case of wide cranial defect on the left fronto-parietal region in a 56-year-old man treated with a personalized titanium plaque obtained by processing the data of a spiral CAT of the skull is described. No complications were observed in the postoperative course and follow-up after 6 moths showed that the patient was in good general condition.
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Clinical Trial
Surgical treatment of common peroneal nerve injuries: indications and results. A series of 62 cases.
Common peroneal nerve (CPN) injuries represent the most common nerve lesions of the lower limb and can be due to several causative mechanisms. Although in most cases they recover spontaneously, an irreversible damage of the nerve is also likely to occur. Nerve regeneration following CPN repair is poorer if compared to other peripheral nerves and this can explain the reluctant attitude of many physicians towards the surgical treatment of these patients. Among the several factors advocated to explain the poor outcome following surgery, it has been suggested that reinnervation might be obstacled by the force imbalance between the functioning flexors and the paralysed extensors that eventually results in the fixed equinism of the foot, due to the excessive contracture of the active muscles and the shortening of the heel cord. Therefore the early correction of these forces might favour nerve regeneration. Following such hypothesis, the authors treat irreversible CPN injuries performing a one-stage procedure of nerve repair and tibialis tendon transfer. We report our experience, describing the indications to surgical treatment, the operative technique and the postoperative clinical outcome correlated with the causative mechanisms of the injuries. ⋯ Surgical treatment of CPN injuries can nowadays be highly rewarding. CPN palsies in open wounds should undergo surgical exploration at emergency. In close injuries with no spontaneous recovery within 4 months after the injury, patients should be advised to seek surgical treatment regardless the causative mechanism of the lesion. According to our experience, the association of a transfer procedure to nerve repair enhances neural regeneration, dramatically improving the surgical outcome of these injuries.
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Clinical Trial
Anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome. Personal experience.
The authors report the results of anterior submuscular transposition, on a clinical series of selected patients with severe cubital tunnel syndrome. In these patients, the degree of ulnar nerve compression was valued using a grading system that includes measurements of motor and sensitive function. In this series, a technique of flexor-pronator mass Z-lengthening was adopted. ⋯ Treatment of severe cubital syndrome by means of a technique of flexor-pronator mass Z-lengthening was linked to 87% rate of good to excellent results. The present study demonstrate the feasibility of this technique with restitutio ad integrum in spite of the severity of the syndrome. None failure nor recurrence was present in this series.
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Review Case Reports
Spontaneous rupture of spinal dermoid cyst with disseminated lipid droplets in central canal and ventricles.
Free fat in the ventricular space is a rare but well recognized complication of ruptured tumour of dermal origin. However, only 1 patient of spontaneous rupture of spinal dermoid tumour with disseminated fat in the central canal and ventricles has been described in the literature. ⋯ Despite being rarely reported, spinal dermoid cyst can rupture spontaneously, and free fat disseminate into the ventricles, and in extremely rare cases, fat can enter into the central canal. It is underlinerd that a prompt detection, with the help of MRI is essential in cases of spinal dermoid tumour cyst, with sudden deterioration in neurological condition, keeping in mind, the possibility of free fat in the central canal.