Can J Neurol Sci
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The management of optic chiasmatic gliomas is controversial, partly related to failure to separate out those tumors involving the optic chiasm only (chiasmatic tumors) from those also involving the hypothalamus (chiasmatic/hypothalamic tumors). The purpose of this study was: (i) to analyze the outcomes of chiasmatic and chiasmatic/hypothalamic tumors separately; and (ii) to determine the appropriateness of recommending radical surgical resection for the chiasmatic/hypothalamic tumors. ⋯ In conclusion, chiasmatic and chiasmatic/hypothalamic tumors are different entities, which should be separated out for the purposes of any study. For the chiasmatic/hypothalamic tumors, there was more morbidity and no prolongation of time to progression when radical resections were compared to more limited resections. Therefore, if surgery is performed, it may be appropriate to do a surgical procedure that strives only to provide a tissue diagnosis and to decompress the optic apparatus and/or ventricular system.
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Communicating disappointing or unexpected neurological news to parents is often both difficult and emotionally unwelcome. At the same time, it is important that transfer of such information is done well and, indeed, if done well, can be a very rewarding experience. Limited references are available for physicians regarding the proper communication of neurological bad news to parents. ⋯ The manner in which neurological bad news is conveyed to parents can significantly influence their emotions, their beliefs and their attitudes towards the child, the medical staff, and the future. This review of the literature, combined with clinical experience, attests to the fact that most families describe emotional shock, upset, and subsequent depression after the breaking of news of a bad neurological disorder. However, the majority find the attitude of the news giver, combined with the clarity of the message and the news giver's knowledge to answer questions as the most important aspects of giving bad news.
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Canadian training in the clinical neurosciences, neurology and neurosurgery, faces significant challenges. New balances are being set by residents, their associations and the Royal College of Physicians and Surgeons of Canada between clinical service, education and personal time. The nature of hospital-provided medical service has changed significantly over the past decade, impacting importantly on resident training. Finally, future manpower needs are of concern, especially in the field of neurosurgery, where it appears that soon more specialists will be trained than can be absorbed into the Canadian health care system. ⋯ Training in neurology and neurosurgery, as in all medical specialties, has changed significantly in recent years and continues to change. Programs and hospitals need to adapt to these changes in order to ensure the production of fully qualified specialists in neurology and neurosurgery and the provision of optimal care to patients in clinical teaching units.
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Review Case Reports
Sarcoidosis presenting as an intramedullary spinal cord lesion.
Sarcoidosis affects the spinal cord in only 0.43% of patients with sarcoidosis. Usually there is systemic involvement prior to the development of cord lesions. We present a case of sarcoid isolated to the intramedullary spinal cord, which was a diagnostic and therapeutic challenge. We review the case and then present a review of the literature with an emphasis on presentation, diagnosis and treatment. ⋯ Fourteen patients have been reported with isolated intramedullary spinal cord sarcoidosis. Current practice supports the role of surgery for biopsy; mainstay of treatment is corticosteroids.
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Since 1991 the author has routinely performed awake craniotomy for intra-axial brain tumors with low complication rate and low resource utilization. In late 1996 a pilot study was initiated to assess the feasibility of performing craniotomy for tumor resection as an outpatient procedure. ⋯ Outpatient craniotomy for brain tumor is a feasible option which appears safe and effective for selected patients. Besides being resource-friendly, the procedure may be psychologically less traumatic to patients than standard craniotomy for brain tumor. Proper prospective studies including satisfaction surveys would help resolve these issues and will be the next step.