World Neurosurg
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Review Case Reports
Isolated internuclear ophthalmoplegia after massive supratentorial epidural hematoma: a case report and review of literature.
Isolated internuclear ophthalmoplegia (INO) after traumatic brain injury (TBI) is rare, with most reported patients having minor head injuries. We report a patient with INO after a massive supratentorial epidural hematoma. We review the literature published since 1966, to summarize the mechanisms of injury and clinical outcomes of INO after TBI. ⋯ INO should be in the differential diagnosis of patients with TBI with an adduction deficit, despite the rarity of the condition. Isolated INO is a relatively benign sequela of TBI, with all but 1 reported patient achieving at least partial recovery over 12 months.
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To review the literature on isolated transverse process fractures (ITPFs) and provide evidence for the current practice of conservative management. ⋯ Our data suggests that nonsurgical management of ITPFs leads to complete resolution of the fracture without evidence of permanent neurologic deficit or spinal instability. However, interpretation of our results is limited by the paucity of meaningful literature reporting on long-term outcomes. Nevertheless, the results provide support for conservative management and highlight the existing need to identify markers or scenarios where the diagnosis of ITPF is actually likely to be erroneous.
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Facial nerve schwannomas are rare, benign, nerve-sheath tumors. They can occur in any segment of the facial nerve and often clinically and radiographically mimic the common vestibular schwannoma when extending into the cerebellopontine angle. The optimal treatment strategy for intracranial facial nerve schwannomas remains controversial. ⋯ Treatment for intracranial facial nerve schwannomas depends on clinical presentation, tumor size, preoperative facial, and hearing function. Conservative management is recommended for asymptomatic patients with small tumors. Stereotactic radiosurgery may be an option for smaller and symptomatic tumors with good facial function. If tumor is large or the patient has facial paralysis, surgical resection should be indicated. If preservation of the facial nerve is not possible, total resection with nerve grafting should be performed for those patients with facial paralysis, whereas subtotal resection is best for those patients with good facial function.
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Osteoporosis is defined as bone mineral density. ⋯ Ongoing additional trials will help formulate preoperative screening recommendations, determine the optimal duration of preoperative and postoperative teriparatide treatment, and investigate its utility in men.
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Multicenter Study
Stereotactic radiosurgery (SRS) for melanoma brain metastases: a comprehensive clinical case series.
Melanoma has high propensity to metastasize to the brain. With recent gains in improving patient survival, stereotactic radiosurgery (SRS) may offer an effective and less neurotoxic alternative to whole-brain radiation. In the study, we report on the safety and efficacy of SRS in treating melanoma brain metastases in 87 patients. ⋯ SRS is a safe and effective treatment option for intracranial metastases from malignant melanoma. This paper serves as a reference for what is achievable in the absence of highly effective systemic therapy.