World Neurosurg
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Levodopa has long been the standard of care for Parkinson disease (PD); however, the eventual onset of motor fluctuations and levodopa-induced dyskinesia (LID) complicates its utility in advanced PD. Current neurosurgical interventions remain some of the best options for LID. Deep brain stimulation (DBS) is currently the procedure of choice for patients with advanced PD, patients refractory to medical management, and patients with motor complications from levodopa therapy. ⋯ Transcranial magnetic stimulation, which can induce local and distant effects in cortical and subcortical areas, has shown efficacy in managing certain PD and LID symptoms in early studies. Finally, direct stimulation of the motor cortex and the cerebellum has shown therapeutic effects in PD and LID patients in certain studies. Taken together, many of these new techniques have shown great promise in early studies and may eventually be preferred treatment options for LID patients.
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The objective of this paper is to discuss relevant data on the epidemiology of hydrocephalus in neurocysticercosis, the new knowledge coming from experimental studies, the pathophysiological mechanisms involved, and the controversies regarding clinical and surgical management, through a comprehensive review of the literature. Hydrocephalus is present at the onset of the disease in 16% to 51% of patients with neurocysticercosis and in 64% to 72% of patients with the extraparenchymal form of the disease. Animal models have successfully reproduced the disease and open new therapeutic approaches perspectives. ⋯ In conclusion, mechanical obstruction and inflammation are the key pathophysiologic mechanisms in the development of neurocysticercosis-induced hydrocephalus. Anthelmintic drugs and surgical options should be used, but they have limitations. A better understanding of the disease can come from experimental models.
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Case Reports
Hemostatic thrombin-gelatin matrix leading to intracranial cyst formation : case report.
Local hemostatic agents have been used in the neurosurgical field for many years; it is safe and efficient with no fatal complication reported in the literature. We routinely used a gelatin-thrombin hemostatic agent (FloSeal Hemostatic Matrix) for hemostasis in minimally invasive endoscopic-assisted surgery for more than 500 patients with intracerebral hemorrhage. However, 2 cases with sterile cyst formation were encountered. ⋯ These sterile cysts were very close to the ventricle wall on images. We hypothesized that cyst wall may be formed not only by hemostatic agent-related fibrosis and inflammation according to the previous literature review but also by the presence of the check valve mechanism between the cyst and the ventricle, which caused further dilation of the cyst.
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Review
A review on the management of cerebral vasospasm following aneurysmal subarachnoid haemorrhage.
Despite decades of research, cerebral vasospasm (CV) continues to account for high morbidity and mortality in patients who survive their initial aneurysmal subarachnoid hemorrhage. ⋯ Proactive and preventive strategies such as oral nimodipine and endovascular rescue therapies can reduce the morbidity and mortality associated with CV.
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Case Reports
Leptomeningeal carcinomatosis following neoplastic cerebral aneurysm rupture: a case report.
Several possible mechanisms exist for the spread of a primary tumor to the leptomeninges in leptomeningeal carcinomatosis. This report describes a case caused by direct bleeding in the subarachnoid space from a neoplastic cerebral aneurysm rupture. ⋯ Tumor cells reach the leptomeninges via hematogenous spread or direct extension from preexisting lesions and can undergo neuraxis dissemination via the cerebrospinal fluid. Subarachnoid hemorrhage and leptomeningeal carcinomatosis are both devastating conditions with extremely poor prognoses. This patient experienced delayed disturbed consciousness leptomeningeal carcinomatosis with decreased performance status, which made it difficult to justify aggressive treatment on the basis of her poor prognosis.