Surg Neurol
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Case Reports
True hemicranial decompression for severe pediatric cranial trauma: a short series of 4 cases and literature review.
Traumatic acute SDH in pediatric patients is a life-threatening situation. There is a severe increase in ICP caused by acute SDH or diffuse brain swelling or secondary to ischemic brain damage. In certain situations, conventional measures may fail to control such a rapid increase in ICP. ⋯ In certain situations, pediatric patients with cranial trauma may be offered hemicranial decompression as a surgical option. These children may have a better long-term outcome despite massive infarcts.
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Surgery for meningiomas involving the cavernous sinus remains controversial. Interdural cavernous sinus is called the lateral dural wall in the cavernous sinus, which is composed of two layers, the outer dural layer and the inner membranous layer. We encountered two cases of dumbbell-shaped middle cranial fossa meningioma with interdural cavernous sinus extension, which were successfully removed by surgical means. ⋯ Middle cranial fossa meningioma with interdural cavernous sinus extension can be removed more easily than other tumors with intracavernous sinus extension and, consequently, can be safely resected without any resulting cranial nerve deficit.
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Rupture of cerebral aneurysms results in subarachnoid hemorrhage. In many cases, bleeding from aneurysms spontaneously arrests. Although bleeding from cerebral aneurysms has been reported to arrest from outside, bleeding from some aneurysms can arrest in different ways. ⋯ The present preliminary study revealed that arrest of bleeding from a ruptured cerebral aneurysm does not always occur from outside the aneurysm. Unusual mechanisms of hemostasis are seen in approximately 12% of ruptured aneurysm. The outside-arrest-pattern aneurysm was more common for smaller aneurysms, and these patients tended to be of better grade. Further studies are necessary to explore the mechanism of hemostasis for ruptured cerebral aneurysms.
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Multilevel laminectomy with instrumented fusion addresses diffuse dorsal cord compression with an adequately preserved cervical lordosis. However, for patients with only 1 to 2 laminar impingement, more "focal" laminectomy and fusion may suffice, the shortened laminectomy allowing for a more simple spinous process fusion skipping the 1 or 2 lamina that have been removed. ⋯ One- and two-level cervical laminectomies with multilevel-instrumented fusion effectively decompressed "focal" cord compression, whereas fusion maintained the cervical lordotic curvature and provided stability to avert future disease progression.
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Endovascular embolization of cerebral aneurysms has evolved rapidly worldwide within the last years, and has gained more popularity at the expense of surgical clipping; however, both regimens have inherent risks. This study was undertaken to asses the cerebral complications associated with both modalities of cerebral aneurysm treatment. ⋯ With rapidly evolving technology of endovascular embolization, accumulated experience, and good selection of patients with optimum angioanatomical criteria and endovascular accessibility, our results of morbidity and mortality associated with both modalities of cerebral aneurysm treatment with short-term outcome show that endovascular embolization of cerebral aneurysms is a safe alternative to surgical clipping in the treatment of both ruptured and unruptured cerebral aneurysms; however, long-term outcome needs to be evaluated.