Neurocirugia
-
Review Case Reports
[Bowstringing as a complication of deep brain stimulation].
Deep brain stimulation (DBS) is an established surgical therapy for intractable movement disorders, such as Parkinson's disease, essential tremor and dystonia. As the number of treated patients has increased rapidly, new sets of problems about complications of DBS have arisen. Bowstringing is defined as abnormal tethering of leads between the pulse generators and stimulating electrode, associated with pain and contracture of the neck over the extension cable. ⋯ Six months after the replacement the patient presented disabling pain and tension in the neck where deep brain extension cables were located. A cervical incision was performed to excise scar tissue. Bowstringing is a rare complication of DBS and although patients sometimes report discomfort and tension in the cervical region, surgical procedures are not normally required.
-
Review Case Reports
[Atypical choroid plexus papilloma in adults: case report and literature review].
Atypical choroid plexus papilloma is a rare tumour, recently defined by the World Health Organisation and with very few cases reported to date. Choroid plexus tumours are rare intraventricular neoplasms originating from choroid plexus epithelium, with benign papillomas being more frequent than carcinomas. Most of these lesions appear in children, mainly located in the lateral ventricles. Those arising from the fourth ventricle are more frequent in adulthood. Surgery with complete resection can be curative in papillomas, with 5-year survival rates close to 100% and occasional recurrences. Radical surgery in carcinomas is difficult and usually requires adjuvant therapy, prognosis is worse and survival rates are lower. We report a case of atypical choroid plexus papilloma in adulthood located in the fourth ventricle, describing the different therapeutic options and reviewing the existing literature. ⋯ Atypical choroid plexus papillomas are associated with an increased risk of recurrence or malignant transformation when compared to "typical" papillomas. At present, complete surgical excision and close follow-up seems to be the most reliable treatment. Adjuvant chemotherapy or radiotherapy should be considered in cases of partial resection, recurrence or dissemination.
-
Case Reports
[Transpterygoid expanded endonasal approach in fibrous dysplasia of the skull base: case report and technical note].
Expanded endonasal approaches (EEA) are becoming a first-level technique for the treatment of skull base pathologies. In some cases, the endoscopic procedures make it possible to dissect structures manipulated with greater difficulty in the classic approaches. We report a full endoscopic transpterygoid EEA for the treatment of a fibrous dysplasia (FD) of the skull base. In addition, we reviewed the English literature available on FD and transpterygoid EEA, establishing an exact surgical technique and showing our intraoperative experience. ⋯ Transpterygoid EEA for treatment of FD of the skull base is a safe and effective procedure, thanks to the guide that the vidian canal provides in finding the lacerum segment of the carotid artery.
-
Although most ischemic strokes are thromboembolic in origin and their management is endovascular or medical, some are haemodynamic in origin and their management may be surgical. We reviewed bypass indications, patient selection and surgical techniques used in our current practice. ⋯ Bypass surgery for the prevention of ischemic stroke is safe and elegant techniques have been developed. Patients with athero-occlusive disease, ischemic symptoms and haemodynamic insufficiency have significant risk of stroke if managed medically or left untreated. However, surgical intervention lacks supporting evidence from the recent Carotid occlusion Surgery Study (CoSS). Patients will be caught in a difficult position between a dismal natural history and an unproven surgical intervention. Clinicians must individualise their management until additional data are published or further consensus develops.