World Neurosurg
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The surgical management of penetrating spinal injury (PSI) has been widely debated in the literature, and the benefit of decompressive surgery for neurological function remains controversial. No national guidelines exist for the PSI population, and surgical practice patterns are unknown. We studied regional and institutional trends in the surgical management of PSI in the United States from 1988 to 2011. ⋯ Decompressive surgery rates for PSI differ significantly across regions and institutions in the United States. Institutional bias, patient preferences, and regional practice patterns all influence decision-making in PSI. A lack of large outcome studies in PSI and the absence of national guidelines contribute to variation in practice patterns. Our study indicates the need for future studies to better describe outcomes in patients with PSI.
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Case Reports
A case report of Hemifacial spasms due to bony stenosis of the Internal auditory meatus: Look beyond the loop.
Hemifacial spasm (HFS) is a neuromuscular disorder resulting from cranial nerve VII compression at the root entry zone, characterized by brief, involuntary, progressive spasms of muscles on one side of face. The cisternal part of cranial nerve VII myelinated by Schwann cells is considered relatively resistant to compression. Rarely, direct compression over this segment without coexistent root entry zone compression may also result in HFS. An aberrant vessel posterior inferior cerebellar artery/anterior inferior cerebellar artery loop remains the leading cause of compression at this location. Cerebellopontine angle tumors or cysts may affect cranial nerve VII distally. However, bony meatal stenosis with pure distal facial nerve compression leading to HFS in the absence of other clinical symptoms has not been reported. ⋯ An aberrant anterior inferior cerebellar artery vascular loop is usually the most frequent lesion causing compression of the distal cisternal part of the facial nerve. However, other purely distal or coexistent lesions must be actively sought for both in preoperative radiologic images and during surgery.
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The most common sites of breast cancer metastases are the bone, lung, liver, and brain. Scalp involvement in breast cancer metastasis is extraordinarily rare. ⋯ Scalp metastasis from breast cancer is an exceedingly infrequent phenomenon. Close attention should be paid to soft tissue masses in patients with a healthy appearance and in those with a history of malignant cancer. When neurosurgeons operate on the mass, the circumscription and depth of the tumor must be given further attention.
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Case Reports
Intra-spinal iliac venous stent migration with lumbar nerve roots compression: a case report.
Venous stenting is a common treatment for chronic peripheral venous disease. The most frequent complications caused by this technique are stent misplacement and intracardiac or intravascular stent migration. In this publication, we will describe the first case of an intraspinal stent misplacement leading to lumbar nerve root compression. ⋯ The intraspinal misplacement of a venous stent is a rare complication that may cause nerve root injury. It requires a prompt treatment. Surgically removing the stent by a posterior approach seems to be a simple and safe therapeutic option.
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Early and late images of 123I-iomazenil (123I-IMZ) single-photon emission computed tomography (SPECT) are considered to show cerebral blood flow and neuronal activity, respectively, and this modality may demonstrate temporal dysfunction of the frontal lobes in obstructive hydrocephalus. In this report, we examined 123I-IMZ SPECT in a patient with chronic obstructive hydrocephalus owing to compression of the aqueduct by a partially thrombosed aneurysm of the left posterior cerebral artery for the first time. ⋯ The findings in the present case indicate that 123I-IMZ SPECT can detect reversible cerebral blood flow reduction and neuronal viability in the frontal lobes, which may affect the clinical manifestation of obstructive hydrocephalus.