World Neurosurg
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Familial cases of idiopathic intracranial hypertension (IIH) are exceedingly rare, and its occurrence in monozygotic twins has not been reported previously. ⋯ This report documents the first case of IIH in monozygotic twins and the associated changes in ICP dynamics. Interestingly, almost equivalent alterations in ICP dynamics were found in the 2 patients.
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Atlantoaxial rotatory subluxation (AARS) is a rare type of traumatic cervical spine injury in adults, commonly manifesting with painful torticollis and suboccipital headache. Early diagnosis is mandatory to avoid catastrophic consequences. We report a rare case of a patient with AARS who presented with nystagmus due to rotational vertebral artery occlusion. ⋯ Careful neurologic examination is of paramount importance in diagnosis and management of cervical spine injuries. Nystagmus, as a well-known manifestation of rotational vertebral artery syndrome, can be the presenting symptom of AARS.
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Diabetes insipidus (DI) is a well-known complication of transsphenoidal pituitary adenoma surgery. However, the risk factors for DI after transcranial surgery have not been clarified. In this study, the clinical parameters for predicting DI after transcranial surgery were investigated. ⋯ The degree of deformation of the third ventricle and hypothalamus assessed by preoperative magnetic resonance imaging may help to predict postoperative DI. Postoperative hemorrhage might increase the incidence of postoperative DI, whether it is immediate postoperative DI or permanent DI.
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Vasospasm after craniopharyngioma surgery, although rare, has been reported. Hypotheses regarding possible causative factors, including major vessel handling during surgery and tumor cyst fluid spillage, do not explain vasospasm occurring in the late postoperative period. We have attempted to consider the probable pathogenic mechanisms of this complication and measures to prevent it. ⋯ Major vessel handling during radical craniopharyngioma surgery is likely to predispose them to spasm, accentuated by rapid shifts of fluid and electrolytes during different phases of DI. This is further complicated by a relative hypocortisolic state caused by tendency to taper off steroids early. Hypocortisolism masks DI leading to dehydration and possibly vasospasm. Once vasospasm develops, it is not easy to reverse. Radiologic reversal with intra-arterial nimodipine may not translate into a good clinical response. Therefore, prudence lies in its prevention. Close monitoring of fluids and electrolytes with optimal steroid cover is necessary until stabilization of DI to prevent this complication.
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Accurate positioning of a ventricle catheter is of utmost importance. Various techniques to ensure optimal positioning have been described. Commonly, after catheter placement, additional manipulation is necessary to connect a burr hole reservoir or shunt components. This manipulation can lead to accidental catheter dislocation and should be avoided. Here, we present a new technique that allows direct endoscopic insertion of a burr hole reservoir with an already mounted ventricle catheter. ⋯ The use of the intracatheter endoscope combined with the modified burr hole reservoir provides a sufficient technique for accurate and safe placement. Connecting the ventricle catheter to the reservoir before the insertion reduces later manipulation and accidental dislocation of the catheter.