Turk Neurosurg
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Case Reports
Clinical characteristics and outcomes of patients with cerebral herniation during continuous lumbar drainage.
The aim of this study was to investigate the clinical characteristics and outcomes of patients who developed cerebral herniation after continuous lumbar cerebrospinal fluid (CSF) drainage. ⋯ Cerebral herniation induced by continuous lumbar drainage is mostly reversible if early identification and prompt management are realized. Faster drainage speed may be associated with earlier occurrence of brain herniation during lumbar drainage.
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Burr-hole craniostomy is the most efficient and safe choice for surgical drainage of chronic subdural hematoma (CSDH). Although the twist-drill drainage is also relatively safe and time-saving, it carries the risk of inadequate drainage, brain penetration and hematoma formation. Our modified technique helps in avoiding bleeding and brain penetration. ⋯ Our modified technique of twist drill drainage is inexpensive, simple, safe and effective alternative technique in the treatment of CSDH.
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In demyelinating disease spectrum, tumor-like (tumefactive) demyelinating lesions (TDL) are rarely seen. Atypical imaging and clinical features of these lesions may cause misdiagnosis of tumor or abscess. ⋯ Although MRI, CSF and pathologic examination help in differential diagnosis of the mass lesions, close follow-up is still crucial for the definite diagnosis. A higher MS conversion rate was found in patients with a younger TDL onset age.
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Case Reports
Compound elevated skull fracture: a clinical series of three patients with a review of the literature.
Compound elevated fracture of the skull is an unusual variety of fracture of the cranial vault that has been rarely described in the currently available literature. The authors describe three such patients with post-traumatic compound elevated skull fracture. The pertinent literature is reviewed, the injury mechanism is highlighted and the management issues are discussed in detail. ⋯ Elevated skull fractures are usually compound injuries. High velocity tangential impact to the skull vault is the most likely causative mechanism in such type of injury. Delay in surgery could lead to intracranial sepsis including meningitis and brain abscess. Thus, these fractures should be aggressively treated.
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Variations in the anatomy of the lateral femoral cutaneous nerve (LFCN) have been reported in the literature. LFCN is vulnerable to injury during several surgical operations, therefore any surgeon intervening in the area should be familiar to its topographic variability. Lesion of the nerve leads to a condition known as "meralgia paresthetica". ⋯ In specific the anterior LFCN branch originated from the femoral nerve, whereas at the level of the inguinal ligament, four nerve branches were present. The existence of multiple LFCN branches could lead to diagnostic confusion in case of "meralgia paresthetica", while if the neurosurgeon is not aware of the potential variability during surgical decompression of the nerve, postoperative complications may occur. The supernumerary LFCN branches could be identified by ultrasound imaging and be used as optimum vascularized grafts for sensory nerve repair.