World Neurosurg
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Case Reports
Diverticular enlargement of the foramen of Luschka and hydrocephalus in a child with Noonan syndrome.
We present an unusual association between Noonan syndrome and tetraventricular hydrocephalus, caused by fourth ventricle outlet obstruction, in a 5-year-old boy. Magnetic resonance imaging showed a diverticular enlargement of the left foramen of Luschka, with compression of the facial nerve that resolved following treatment of hydrocephalus by endoscopic third ventriculostomy.
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The cause of postoperative heterotopic ossification (HO) after cervical disc replacement (CDR) is unclear. The aim of the present study was to investigate the incidence of HO, its clinical significance, and whether the degree of preoperative degeneration was associated with its occurrence. ⋯ The presence of HO after CDR was a relatively frequent finding at the final follow-up visit but did not influence patients' improvements. Segments with higher grades of preoperative degeneration had a greater incidence of HO; thus, HO is likely a reflection of the degeneration process.
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Recent advancements in understanding the molecular basis of gliomas and new concepts of neuronal plasticity have shown the importance of maximal resection in gliomas to improve progression-free overall survival. Awake craniotomies with intraoperative cortical and subcortical mapping have helped to achieve this aim while allowing us to preserve executive function including language. Language mapping becomes a daunting task in individuals who are bilingual because of the complexity of varied cortical representation of different languages. ⋯ Advancements in anesthesia and neuromonitoring have further allowed for long awake periods, permitting complex language tasks to be tested intraoperatively. The results obtained from this case study have allowed us to further plan for awake surgeries for patients with bilingualism. With understanding bilingual representation of languages, we hope to achieve maximal resection with minimal postoperative deficits.
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Previous studies have described the association of spinal epidural lipomatosis with several conditions including chronic steroid therapy, Cushing's syndrome, obesity, Paget disease, and hypothyroidism. We present a report of rapid development of spinal epidural lipomatosis after treatment with second-generation anti-androgen therapy, a new strategy for treatment of metastatic castration-resistant prostate cancer that has been increasingly employed in the past few years. A comprehensive discussion of the underlying molecular networks involving androgen receptor blockage and adipocyte differentiation, as well as the clinical implications of such a phenomenon, are provided. ⋯ The underlying pathophysiology of adipose tissue growth following the administration of anti-androgen therapy is discussed, with emphasis on both the canonical Wnt/β-catenin pathway as well as in the Wnt-independent pathway involving direct activation of downstream transcription factors from the T-cell factor family by the androgen receptor. As second-generation androgen receptor antagonists have been increasingly used for treatment of castration-resistant stage metastatic prostate cancer, new onset of symptomatic epidural lipomatosis should be considered as a possible differential diagnosis, especially because the urinary symptoms of cauda equina compression may be improperly attributed to the primary prostate neoplasm.
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Postoperative contact selection of deep brain stimulation (DBS), testing one contact at a time, is a clinically time-consuming procedure being challenged by incoming applications of more complex DBS leads. The objective of this study is to guide clinicians to select the optimal contact by neuroanatomic information derived from electrode reconstruction. ⋯ Electrode reconstruction could assist in selecting the clinical optimal contact and improving its efficiency.