Surg Neurol
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The ligamentum flavum is the anatomic plane between the epidural and laminar-extralaminar spaces, which should be meticulously preserved for a possible reoperation. Preservation of the ligamentum flavum together with other epidural anatomic structures, such as epidural fat tissue and venous plexuses, and limited removal of the lamina are important components in preventing epidural fibrosis that may be the cause of failed back surgery syndrome. ⋯ The ligamentum flavum preserving technique is useful in achieving a favorable long-term outcome, and reoperation, if necessary, is easier and safer.
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Moyamoya disease was initially described by Suzuki and Takaku in 1963 as a radiographic phenomenon relating to the tiny collateral vessels characteristic of the disease that resemble a cloud or puff of smoke. The disease is rare and initially it was believed that the disease was confined to the Japanese population. It consists of occlusive vascular disease at the Circle of Willis with a tendency toward multiple ischemic neurological events and small strokes. In older populations it can often be associated with further vascular degeneration and intracerebral hemorrhage. This paper discusses the diagnosis, treatment, and management of moyamoya disease in a Hispanic child. ⋯ This article reports the occurrence of moyamoya in a Hispanic child. It illustrates the improved perfusion postoperatively as seen on digital subtraction cerebral angiography. Direct revascularization is felt to be difficult in children and alternatives such as encephaloduroarteriosynangiosis have been advocated. Direct revascularization was effective in treating moyamoya disease in this instance. Most of the discussion of moyamoya disease has been focused on the Japanese and Far East population. This report confirms the entity as occurring in a Hispanic individual in the United States with no known Japanese ancestry.
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This article investigates nitric oxide (NO) metabolism following severe head injury (SHI). We wished to clarify the alterations of NO metabolism end products that is associated with SHI, and to delineate the role of inflammation in this process. ⋯ In patients with SHI, CSF concentrations of the dominant metabolites of NO are elevated in the first 3 days after trauma. A similar concurrent spike in the CSF level of IL-8, a marker of acute inflammatory response, can also be demonstrated. These data indicate that the predominant cause of the higher CSF NO(-)(2) + NO(-)(3) concentrations observed in SHI is most likely inflammation.
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In this study, we report on the effectiveness and usefulness of two-staged gamma knife radiosurgery (GKS) for large petroclival and cavernous sinus meningiomas that have a high rate of surgical morbidity. ⋯ Although we have treated only 7 patients using two-staged GKS, we believe this treatment may be a very useful option for large petroclival and cavernous sinus meningiomas in selected patients.
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Review Case Reports
Ganglioglioma of the brainstem: report of three cases and review of the literature.
Brainstem gangliogliomas are rare low-grade tumors that usually have a long clinical history. However, they may cause sudden death. There are only 31 cases of brainstem ganglioglioma reported in the literature, and only one has been studied with magnetic resonance (MR). We present three new cases of brainstem ganglion cell tumor studied with computed tomography (CT) (3 cases) and MR (2 cases) and discuss the clinical presentation, diagnostic imaging and treatment of these tumors. ⋯ Imaging characteristics of brainstem gangliogliomas do not seem to differ from those in other locations and are not specific. Radical surgery is rarely if ever possible, nor is it advisable because of the risk of functional deterioration. However, because of their benign histology, partial resection seems to carry a similar prognosis as tumors in other locations that are amenable to complete resection.