World Neurosurg
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Case Reports
Overshunting-Associated Myelopathy (OSAM) in a Patient with Bilateral Jugular Vein Occlusion.
Overshunting-associated myelopathy (OSAM) is a very rare complication of ventricular shunt therapy, and only 11 previous cases have been reported in the literature. We report the successful surgical management of a case of OSAM in a patient with bilateral jugular vein occlusion and congenital hydrocephalus. ⋯ OSAM has to be considered according to the Monro-Kellie doctrine and is affected by an engorgement of the epidural cervical venous plexus, which can produce cervical myelopathy. Because it can be treated simply by increasing the shunt resistance, surgeons should be aware of the rarely detected overdrainage complication.
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To identify risk factors for predicting posttraumatic hydrocephalus (PTH) development after traumatic brain injury in patients who underwent decompressive craniectomy (DC). ⋯ GCS scores <6 on admission, presence of IVH on first head computed tomography scan, and need for bilateral DC might be used to predict whether patients with traumatic brain injury after DC will develop PTH. The reliability of this specific combination might be useful for clinicians to make a correct prediction.
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Paragangliomas of the head and neck region are not only rare but also unique in that they are derived from the parasympathetic system and are nonsecretory. Orbit represents 1 of the least common sites for head and neck paragangliomas. Orbital paraganglioma remains predominantly a disease of adults, and it has never been reported in infancy earlier. Therefore it is not known if these tumors in infancy behave any differently than their adult counterparts. ⋯ Orbital paraganglioma in infancy may be more aggressive than the adult counterparts. Although simple excision without adjuvant radiation may be tried in localized tumors with intact vision, recurrence tends to be high. Orbital exenteration with or without radiotherapy remains the only salvage option in such recurrences.
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Although gun-related penetrating traumatic brain injuries make up the majority of cranial missile injuries, low-velocity penetrating injuries present significant clinical difficulties that cannot necessarily be identically managed. Bow hunting is an increasingly popular pastime, and a crossbow allows a unique mechanism to cause a self-inflicted cranial injury with a large, low-velocity projectile. Historically, arrow removal is described in an operating room setting, which provides limited knowledge of the location of vascular injury in the setting of postremoval hemorrhage, and may represent an inefficient use of operating room availability. ⋯ We describe a novel approach to retained cranial arrow removal in a radiologic, rather than operative, setting and describe its relative benefits over traditional removal in the operating room.
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Aggressive vertebral hemangiomas are rare tumors of the spine. The treatment management strategy usually consists of vertebroplasty, radiation therapy, or, in rare cases of surgical strategy. ⋯ Here we demonstrate the usefulness of radiofrequency ablation technique as an alternative treatment, as well as robotic assistance for optimal placement of the ablation probe within the lesion.