Surg Neurol
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Actinomycosis of the central nervous system is a rare disease that most frequently forms cerebral abscesses. In the present report, we describe an extremely rare case of spinal intrathecal actinomycosis. ⋯ The clinical course and serial changes of Gd-MRI findings are important considerations when this rare and infectious spinal lesion is suspected.
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Craniotomy with a mechanical twist drill is a standard, minimally invasive procedure in neurosurgery, widely used for the drainage of chronic subdural hematomas and the placement of ventricular drains. Nevertheless, the use of a standard twist drill trephine bears the risk of causing cerebral lesions. ⋯ The described modified mechanical twist drill enables fast, easy, and safe craniotomy without jeopardizing the advantages of a mechanical twist drill. Therefore, it can be recommended particularly for difficult emergency conditions.
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The authors report their personal experience in the management of cerebral arteriovenous malformations (AVMs), using the three techniques now available: surgical resection, endovascular embolization, and radiosurgery. They review the recent literature on this topic and present their current management algorithm based on this experience. ⋯ In this management algorithm, AVMs submitted directly to surgery or to radiosurgery were considered "good risk" malformations, and the outcome for these cases was good in terms of clinical result and cure rate. AVMs submitted first to endovascular embolization were considered "poor risk" malformations, including a majority of Spetzler Grade IV-V lesions. Not surprisingly, the majority of severe complications occured in this group during embolization. Thus, the major risk of the treatment of AVMs has now shifted from surgery to endovascular techniques. Endovascular embolization as sole treatment gave a low rate of complete occlusion, but proved to be very useful as a reductive therapy, in preparation for further surgery or radiosurgery. Partial embolization permitted high rates of complete cure in difficult AVMs. Embolization should be used to the maximum extent possible as a reductive technique, despite the risks of the procedure. Because of its risks however, this technique of reductive embolization should be used only if absolutely necessary to allow the complete cure of the malformation. Thus, the use of embolization should be considered very cautiously in small malformations as well as in very large and complex AVMs in which partial embolization will not be sufficient to allow complete cure with either endovascular or surgical techniques.
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The aim of this study was to analyze the effect of early surgical management protocol and other important clinical features on the prognosis of patients suffering from war missile skull base injuries. ⋯ Although the wounds were associated with a high mortality rate, this study showed that there are major differences in prognosis of patients with war missile skull base injuries with respect to certain presenting clinical features.
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It is known that a "dissociated motor loss" of the deltoid muscle can occur with disconcerting frequency after cervical spine surgery. The etiology of this entity is in question. We conducted an anatomic study to identify anatomic factors that might predispose C5 to injury. ⋯ To our knowledge, the second finding has not been reported previously. The first and third findings may help explain why C5 is more vulnerable to injury.