Surg Neurol
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To analyze, prospectively, the long-term effects of continuous intrathecal morphine infusion therapy in 16 patients with chronic nonmalignant pain syndromes. ⋯ In our experience, the administration of intrathecal opioid medications for nonmalignant pain is justified in carefully selected patients.
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Review Case Reports
Calvarial hemangiomas: report of two cases and review of the literature.
Primary hemangiomas of the bone are uncommon tumors, accounting for less than 1.0% of all bone neoplasms. These tumors are mostly found in vertebral bodies. Hemangiomas are rarely seen in the calvarium, where their frequency is 0.2% of all bone neoplasms. Because of their infrequent appearance in the skull, vague symptoms, and absence of prototypical radiological findings, these tumors can be missed in many cases or may be misinterpreted as more ominous lesions like multiple myeloma or osteosarcoma. ⋯ Histopathologic confirmation of the tumor is the definitive method for diagnosis of intraosseous hemangiomas. Radiological findings are not always characteristic for calvarial hemangiomas. Due to possible complications and the possibility of effective treatment, this lesion should always be considered in the differential diagnosis of skull lesions.
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Case Reports
Vertebral artery pseudoaneurysm complicating posterior C1-2 transarticular screw fixation: case report.
Vertebral artery injury during posterior C1-2 transarticular screw fixation occurs in approximately 3% of patients and may remain asymptomatic or result in arteriovenous fistulae, occlusion, narrowing, or dissection of the vertebral artery, and lead to transient ischemic attacks, stroke, or death. ⋯ Vertebral artery pseudoaneurysm complicating posterior C1-2 transarticular screw fixation may be effectively treated with endovascular approaches.
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Traumatic occipitoatlantal dislocation (OAD) is a severe ligamentous injury resulting in instantaneous death or severe neurological deficit. However, survivors of OAD, both short and long term, have been increasingly reported; this may be because of improved prehospital care, more rapid transportation, a high index of suspicion, and new radiological techniques. ⋯ Early recognition and treatment may improve the outcome of this injury. Treatment consists of early respiratory support and subsequent surgical fusion.
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We assessed the risk of delayed subdural hematoma and other complications associated with subdural grid implantation. ⋯ In our experience the worst complication of subdural grid implantation has been delayed subdural hematoma. Placement of subdural drains and close observation may be helpful to prevent this serious complication.