World Neurosurg
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5-aminolevulinic acid (5-ALA) has been increasingly used in recent years to identify anaplastic foci in primarily suspected low-grade gliomas (LGGs). However, 5-ALA fails to visualize a subgroup of focally anaplastic gliomas. Recently, 2 in vitro studies and 1 in vivo study assumed that antiepileptic drugs (AEDs) and dexamethasone have an influence on the 5-ALA metabolism/visible fluorescence in gliomas. The aim of this study was to analyze for the first time the influence of different AEDs and dexamethasone on visible 5-ALA fluorescence in a large cohort of suspected LGG. ⋯ In the largest series to date, we did not find a drug-related influence of either dexamethasone or different AED on visible 5-ALA fluorescence in suspected LGG. According to our preliminary data, preoperative treatment with these common drugs in neurosurgery can be performed safely before 5-ALA-assisted surgery of suspected LGG.
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Idiopathic intracranial hypertension (IIH) is a chronic condition characterized by raised intracranial pressure in the absence of a known etiology. IIH typically presents in overweight women of childbearing age. Surgical intervention for IIH involves diversion of cerebrospinal fluid, often by the placement of a shunt. Experience suggests higher shunt failure rates in patients with IIH than shunts placed for other etiologies. Here we sought to both establish and compare failure rates for IIH and non-IIH shunts and to examine association with body mass index (BMI). ⋯ Our study suggests that in IIH, relative to hydrocephalus of other causes, shunts have higher failure rates and often require more frequent revisions. Higher shunt failure rates in patients with IIH may be associated with an unhealthy BMI.
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Case Reports
Tuberculoma of the peripheral nerve: Illustrative case and systematic review of literature.
Tuberculomas affecting the peripheral nerve are exceedingly rare. As such, little has been reported about their clinical features, treatment, and outcomes. ⋯ Tuberculoma of the peripheral nerve is a rare manifestation of tuberculous disease, with a predilection for the ulnar nerve. Current management includes nerve exploration, lesion resection, and antitubercular treatment, which often results in good neurologic recovery.
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Pneumocephalus is a life-threatening event associated with different infectious diseases and trauma. Klebsiella pneumoniae is a gas-forming organism that can cause pneumocephalus. A woman aged 56 years presented with a history of septic shock and community-acquired pneumonia. ⋯ The computed tomography scan of the brain revealed abundant pneumocephalus entities. Multidrug-resistant K. pneumoniae was found in her cerebrospinal fluid while on appropriate antibiotic therapy. She died from acute stroke during her treatment.
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Giant, previously coiled basilar tip aneurysms are difficult to cure. ⋯ Until endovascular treatment is proven on a long-term basis to cure similar aneurysms, surgery should remain an option.