Surg Neurol
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Case Reports
Use of tissue adhesive to secure spinal epidural stimulating electrodes: technical note.
Securing spinal cord stimulating electrodes (SCS) within the epidural space is often a challenging task. Complications of the technique include development of cerebrospinal fluid leaks and electrode migration. ⋯ Two-year follow-up shows no migration of the electrodes. Tissue adhesive of "fibrin glue" is a viable alternative for securing epidural SCS electrodes.
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An unusual postoperative complication of percutaneous thermocoagulation of the gasserian ganglion is reported. Computed tomography and magnetic resonance imaging of the brain disclosed an intracerebral lesion following the surgical procedure. Some rare abnormalities of the skull base could increase the risk of such complications. A meticulous surgical technique with fluoroscopic and neurophysiological control is mandatory in any percutaneous procedure on the trigeminal ganglion.
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Transcranial doppler sonography was performed transorbitally in five patients clinically diagnosed as unilateral carotid-cavernous fistula. Dural arteriovenous malformation related-shunts were detected in all the patients. In the normal eyes, the only doppler signals observed at an insonation depth of 45 to 55 mm were those of the ophthalmic artery. ⋯ In two cases, however, the observed flows were directed posteriorly, the normal direction of these veins. The possible explanations for this discrepancy are discussed in relation with angiographic findings. The use of transcranial doppler might provide a better understanding about hemodynamic changes in carotid cavernous fistulas.
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Case Reports
Intracerebral hemorrhage from a middle meningeal arteriovenous fistula with a giant venous varix.
A patient with a congenital arteriovenous fistula between the middle meningeal artery and a cortical vein with a giant venous varix is described. The patient presented with an intracerebral hemorrhage that had been evacuated. Permanent cure of the fistula was achieved without morbidity by embolization with Ivalon particles.
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Among the frequently utilized intracranial pressure (ICP) monitoring devices employed in neurosurgical practice is the Camino fiberoptic monitor. Several recent studies have described results with the Camino monitor and compared it with other forms of ICP monitoring with varying results and conclusions. The aim of this study was to compare simultaneous ICP readings from the Camino fiberoptic monitor placed in the brain parenchyma and from a ventricular catheter. ⋯ It was determined that the Camino ICP measurements exceeded those of a ventricular catheter in 66% of total measurements for the 10 patients. The mean ICP difference between the Camino fiberoptic system and the ventricular catheter was 9.2 +/- 7.8 mm Hg. This result suggests that the correlation between intraparenchymal pressure measured by the Camino fiberoptic monitor and the intraventricular pressure is not as close as previously described.