World Neurosurg
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Obstructive hydrocephalus secondary to posterior cranial fossa space-occupying lesions is common, and treatment includes shunting or removal of the causative lesion. The list of posterior fossa space-occupying lesions is exhaustive and includes tumors, cysts, and tumor-like conditions. ⋯ However, unrelated pathologies could coexist and may be overlooked. We hereby describe an unusual case of a posterior fossa cystic, suspected metastatic lesion presenting with moderate to severe hydrocephalus in a patient with oral cavity cancer on chemotherapy, which turned out to be cysticercosis on excision, leading to a diagnostic dilemma; hence the adage "cyst with a twist"!
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The purpose of this study is to evaluate the clinical effects of cervical spinal cord injury without fracture and dislocation (CSCIWFD) treatment in a medium-to long-term follow-up study. The clinical treatment of CSCIWFD is also discussed. ⋯ Early surgical treatment for CSCIWFD can directly relieve spinal cord compression. The medium-to long-term follow-up revealed that surgery clearly promotes decompression.
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Awareness of the osseous anomaly of ponticulus posticus (PP) is crucial in avoiding vertebral artery (VA) injuries during C1 instrumentation. The aim of this study was to investigate PP and its relationship with the VA with three-dimensional computed tomography angiography. ⋯ The presence of the PP loop can limit space available for placement of the screw through the bony elements of C1. Standard screw techniques are contraindicated owing to the unacceptable high risk of VA injury.
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"White cord syndrome" is a very rare condition thought to be due to acute reperfusion of chronically ischemic areas of the spinal cord. Its hallmark is the presence of intramedullary hyperintense signal on T2-weighted magnetic resonance imaging sequences in a patient with unexplained neurologic deficits following spinal cord decompression surgery. The syndrome is rare and has been reported previously in 2 patients following anterior cervical decompression and fusion. We report an additional case of this complication. ⋯ The rare white cord syndrome following either anterior cervical decompression and fusion or posterior cervical decompression and fusion may be due to ischemic-reperfusion injury sustained by chronically compressed parts of the spinal cord. In previous reports, patients have improved following steroid therapy and acute rehabilitation.
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Brain tumor surgery near or within eloquent regions is increasingly common and is associated with a high risk of neurologic injury. Awake craniotomy with mapping has been shown to be a valid method to preserve neurologic function and increase the extent of resection. However, the technique used varies greatly among centers. Most count on professionals such as neuropsychologists, speech therapists, neurophysiologists, or neurologists to help in intraoperative patient evaluation. We describe our technique with the sole participation of neurosurgeons and anesthesiologists. ⋯ We provide a thorough description of the technique used in awake craniotomies with mapping used in our institution, where the intraoperative patient evaluation is carried out solely by neurosurgeons and anesthesiologists. The absence of other specialized personnel and equipment does not necessarily preclude successful mapping during awake craniotomy. We hope to provide helpful information for those who wish to offer function-guided tumor resection in their own centers.