Neurochirurgie
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Different types of neurostimulation are proposed essentially in cases of chronic neuropathic pain, non controlled by anticonvulsivants and antidepressants. The aim is usually to activate a failing inhibitory system, involved in the transmission and the modulation of the nociceptive stimulus. The site of stimulation (transcutaneous, spinal cord, thalamic) is choosen according to the severity of pain and especially the degree of lemniscal dysfunction evaluated by clinical and electrophysiological data. ⋯ When dysfunction or lesion extend to the pre-ganglionic portion, it's preferable to propose stereotactic thalamic stimulation or central gyrus stimulation. The analgesic effect concerns permanent burning pain in the context of sensitive deafferentation: after distal nervous lesions, radicular, plexular or spinal lesions or after stroke with ischemic lesions along the nociceptive pathways. These different methods must only be proposed if there is a frequent clinical and technical monitoring.
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Review Case Reports
[Cerebellar hemorrhage complicating a supratentorial craniotomy. A case report and review of the literature].
Postoperative cerebellar hemorrhage after a supratentorial craniotomy represents a rare event. We report a case of a patient with a meningioma of the jugum who developed suddenly after surgery a neurological deterioration due to a cerebellar hemorrhage detected on the CT scan. An occipital craniectomy and an external ventricular drainage were performed in emergency. ⋯ Pre- and postoperative high blood pressure, lowered intracranial pressure and mispositioning of the head during surgery could be at the origin of the hemorrhage. Size of the hemorrhage, time between diagnosis and treatment represent two prognostic factors. All patients, who present a neurological deterioration in postoperative course, must have CT scan including posterior fossa.
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Review Case Reports
[Arachnoid cysts of the middle fossa and associated subdural hematoma. Three case reports and review of the literature].
We report 3 cases of subdural hematoma associated with arachnoid cyst of the middle fossa, and discuss the treatment. ⋯ We propose subdural hematoma drainage without any specific treatment (shunt or fenestration) of the arachnoid cyst, for this category of patient.
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Review Case Reports
[Spontaneous temporo-sphenoidal encephalocele. A case report].
A case of anteromedial temporo-sphenoidal meningo-encephalocele in a 43-year-old woman is reported. She was referred to us after a five-year history of rhinorrhea of CSF. Three years ago, she presented an epileptic seizure. ⋯ Some cases have been successfully treated via a transsphenoidal route. However, surgical failures related to this approach can be due to the lack of control of the lateral recess of the sphenoid sinus. Therefore, the frontotemporal approach seems more adequate.
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Case Reports
[Neurofibromatosis type 2. Preliminary results of gamma knife radiosurgery of vestibular schwannomas].
The aim of this study was to assess tolerance and efficacy of gamma knife radiosurgery on vestibular schwannomas for patients affected with neurofibromatosis type 2. ⋯ Our experience confirms that tolerance of gamma knife radiosurgery compares favorably with microsurgery of bilateral vestibular schwannomas. This treatment should be restricted to small and medium growing tumors. Treatment strategy of neurofibromatosis type 2 patients should be planned by multidisciplinary experienced teams disposing of the whole armamentarium. A longer follow-up study is required to confirm the current results regarding the tumor control rate.