World Neurosurg
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On the basis of recent findings about the pathophysiology of cluster headache and through the experience reported in recent literature, we have reviewed the outcome of four patients affected by drug-resistant cluster headache treated in our department by posterior hypothalamic deep brain stimulation with a follow-up of more than 5 years. ⋯ The long-lasting pain reduction and the improvement in the patients' symptoms should be considered a real positive prospective, not only because there was uncertainty about the persistence of the beneficial effects at a long-term follow-up, but also for the improvement of the quality of life. The stimulation can restore important aspects concerning the psychic condition that very often constitutes an important limiting factor in normal daily life for this type of patient.
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To evaluate the attitudes and perceptions of medical student toward neurosurgery. ⋯ The findings identify some areas that may be targeted to stimulate and improve medical students' interest and passion toward the pursuit of neurosurgery as a specialty and ultimately to improve their learning experience.
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Prognosis of tinnitus after acoustic neuroma surgery--surgical management of postoperative tinnitus.
Tinnitus is a bothersome symptom for patients with acoustic neuroma. We studied the possibility of surgical control of postoperative tinnitus associated with acoustic neuroma. ⋯ Deciding whether to cut the cochlear nerve during acoustic neuroma surgery by referring to a flowchart, we proposed in cases where hearing preservation is not intended or judged less possible contributes to controlling postoperative tinnitus. However, regardless of whether the cochlear nerve was cut intraoperatively, tinnitus remained unchanged in 37% of patients, suggesting that their tinnitus originates in the brainstem or post-brainstem pathways before surgery, and it is considered difficult to control postoperative tinnitus in these cases.
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Historical Article
Models of functional cerebral localization at the dawning of modern neurosurgery.
The concept of a functional cerebral localization gave the needed support for the development of neurosurgery as a specialty. It should be noted though that the presence of functions on discrete areas of the cortex was a very controversial topic at that time. The objective of this paper is to review models of cortical organization at the end of the 19th century, highlighting beliefs, theories, and controversies behind them. A better understanding of this historical moment is essential to appreciate the debate between holists and localizers that stirred neuroscientists worldwide in the first half of the 20th century.
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Case Reports
Cranial reconstruction for treatment of intracranial hypertension from sclerosteosis: case-based update.
Sclerosteosis (OMIM 269500) is a progressive, autosomal recessive, sclerosing bone disorder with a well defined phenotype. This phenotype is correlated with a deficiency in the protein product sclerostin, leading to bony overgrowth from the loss of inhibition of osteocyte function. Calvarial overgrowth can lead to cranial nerve palsies, visual impairment, and compression of the medulla at the foramen magnum. There is a presumption that calvarial thickening may lead to elevated intracranial pressure in these patients, although pressure measurements have not been published. ⋯ After surgery, the patient had resolution of the headaches and radiographic near-resolution of the syrinx. The authors review their experience and the relevant literature with this rare case.