Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Controlled Clinical TrialSimple solution for preventing cerebrospinal fluid loss and brain shift during multitrack deep brain stimulation surgery in the semisupine position: polyethylene glycol hydrogel dural sealant capping: rapid communication.
This study evaluated preliminary findings on the efficacy of polyethylene glycol (PEG) hydrogel dural sealant capping for the prevention of cerebrospinal fluid (CSF) leakage and pneumocephalus during deep brain stimulation (DBS) surgery in the semisupine position. Group A consisted of 5 patients who underwent bilateral subthalamic nucleus (STN)-DBS surgery without PEG hydrogel dural sealant capping. Group B consisted of 5 patients who underwent bilateral STN-DBS surgery with PEG hydrogel dural sealant capping. ⋯ No hemorrhage or venous air embolisms were observed in either group. The effect of brain shift was discriminated by STN recordings in Group B. These preliminary findings indicate that PEG hydrogel dural sealant capping may reduce adverse effects related to CSF leakage and brain shift during DBS surgery.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
ReviewMechanisms of tumor development and anti-angiogenic therapy in glioblastoma multiforme.
Despite advances in surgical and medical therapy, glioblastoma multiforme (GBM) remains a fatal disease. There has been no significant increase in survival for patients with this disease over the last 20 years. ⋯ In this review, we focus on the molecular characteristics of angiogenesis and invasion in human malignant glioma. We discuss bevacizumab and cilengitide, which are used to inhibit angiogenesis in GBM.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Critical classification of craniostomy for chronic subdural hematoma; safer technique for hematoma aspiration.
Chronic subdural hematoma (CSDH) is generally treated by twist drill, and one and two burr-hole craniostomy. We proposed new classification of the intraoperative condition of CSDH, and present a safer technique for aspiration of CSDH in one burr-hole surgery. The intraoperative condition of CSDH was classified according to the connections between the hematoma cavity and the extracranial space as follows. ⋯ There were no special complications. The recurrence rate was average. The substitution of saline after complete aspiration of hematoma carries little risk only under the "open condition," shortens the operation time, and achieves good irrigation of the hematoma.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Case ReportsStereotactic biopsy and drainage of a brainstem abscess caused by Listeria monocytogenes.
Listerial rhombencephalitis and brain abscesses are rare, but potentially life-threatening conditions. Early initiation of antibiotic therapy is crucial, but establishing the diagnosis of listerial brainstem abscess can be difficult. Stereotactic biopsy and drainage of space-occupying abscesses of the brainstem should be considered especially in cases of rapid clinical deterioration. We successfully performed stereotactic biopsy and drainage of a listerial brainstem abscess in a 42-year-old male patient who deteriorated despite antibiotic treatment, demonstrating that this approach is suitable in such patients.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Case ReportsFacial nerve schwannoma arising from the cerebellopontine angle.
A 74-year-old female suffered hearing disturbance in the right ear persisting for several years, followed by sudden onset of right facial nerve palsy. Her symptoms gradually worsened and neuroradiological imaging revealed a 4-cm cerebellopontine angle (CPA) tumor. Intraoperatively, the tumor was found to originate from the facial nerve. ⋯ However, preoperative diagnosis of facial nerve schwannomas is important because functional preservation of the facial nerve is more challenging than for vestibular schwannomas. Facial nerve palsy is one of the most unique symptoms in patients with facial nerve schwannomas, but is rare with vestibular schwannomas. Facial nerve schwannomas should be included in the differential diagnosis of CPA tumors with atypical clinical manifestations, and patients should be informed before surgery of the possibility of facial nerve dysfunction and the consequent need for facial nerve graft or reconstruction.