World Neurosurg
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Recommended treatments for spontaneous intracranial hypotension (SIH) range from bed rest only to neurosurgery. However, the serious form of SIH is poorly defined. A better description of patient characteristics and their outcome may help define therapeutic options. ⋯ The presence of SDHs, disturbance of consciousness, and a trend toward a longer time to diagnosis and recovery seem to define the serious form of SIH. These patients may require exploration and surgical repair of cerebrospinal fluid leak, only after failure of conservative measures--bed rest and time--and EBP, with good outcome.
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Case Reports
Intraneural hematoma: a proposed anatomic classification with potential treatment implications.
Intraneural hematoma is a rare entity with fewer than 20 cases reported in the literature. There is no consensus on surgical treatment due to its rarity. ⋯ This classification system localizes the hematoma to the different connective tissue layers that compose the nerve: the paraneurium, epineurium, and perineurium. We believe that this classification has consequences for surgical treatment and can form the foundation for future research into the natural history of these types of lesions.
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Comparative Study
Importance of IL-6, MMP-1, IGF-1 and BAX Levels in Lumbar Herniated Discs and Posterior Longitudinal Ligament in Patients with Sciatic Pain.
The aim of this study was to evaluate prognostic importance of interleukin-6 (IL-6), matrix metalloproteinase (MMP)-1, insulin-like growth factor (IGF)-1, and Bcl-2-associated X protein (BAX) levels in biopsy specimens taken from the intervertebral disk specimens and the posterior longitudinal ligaments of patients with sciatic pain. ⋯ Our findings suggest that the cytokines, enzymes, growth factors, and proapoptotic proteins, such as IL-6, MMP-1, IGF-1, and BAX, may be critical factors in the pathophysiology of the degeneration of the intervertebral disks in patients with symptomatic degenerative disk disease.
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Comparative Study
The Role of Endoscopic Assistance in Ambient Cistern Surgery: Analysis of Four Surgical Approaches.
We used microscopy with endoscopic assistance to conduct an objective analysis of 4 surgical approaches commonly used in the surgery of the ambient cistern: infratentorial supracerebellar (SC), occipital interhemispheric (OI), subtemporal (ST), and transchoroideal (TC). In addition, we performed a parahippocampalis gyrus resection in the ST context. ⋯ This study demonstrates that endoscope assistance improved exposure of the ambient cistern region when using the ST approach. Endoscopic assistance provided similar surgical exposure compared with ST associated with parahippocampalis resection.
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Whole brain radiation treatment (WBRT) is considered standard treatment for BM. However, exposing large volumes of normal brain tissue to irradiation can cause neurotoxicity. This study describes our experience with 100 consecutive patients with brain metastases who were managed with surgical extirpation followed by stereotactic radiosurgery (SRS) to the resection cavity. ⋯ The strategy described provides acceptable local disease control when compared with WBRT following surgery. This approach can delay and even annul WBRT in the majority of selected BM patients, especially recursive partitioning analysis class I patients. SRS should be scheduled as soon as possible after surgery.