Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2014
Factors associated with blunt cerebrovascular injury in patients with cervical spine injury.
Blunt cerebrovascular injury (BCVI) is known to be a potentially fatal complication of cervical spine injury (CSI). Methods for screening the appropriate population remain to be elucidated, especially in Japan. This retrospective study was conducted to predict the risk factors relevant to BCVIs. ⋯ Multiple logistic regression analyses for BCVI and BVAI were carried out using stepwise methods. On univariate and multivariate analysis, hyperextension injury was significantly associated with BVAI (p = 0.01 and p = 0.02), and subluxation (dislocation of vertebral body > 5 mm) was a significant predictor of BCVI (p = 0.04 and p = 0.03) and BVAI (p = 0.01 and p = 0.01). Prompt evaluation for BCVIs is recommended in CSI patients with hyperextension injury and dislocation of the vertebral body.
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Neurol. Med. Chir. (Tokyo) · Jan 2014
Is Simpson grade I removal necessary in all cases of spinal meningioma? Assessment of postoperative recurrence during long-term follow-up.
It is generally accepted that the first choice of treatment for spinal meningiomas is "radical" surgical removal. However, Simpson grade I removal is sometimes difficult, especially in cases with ventral dural attachment, because of the risk of spinal cord damage or the difficulty of dural repair after radical resection. In addition, there is no consensus on a surgical strategy for radicality, whether or not Simpson grade I resection should be performed in all cases of spinal meningioma. ⋯ Of these 3 recurrent cases, 1 was a case of non-dura-based meningioma and another was a case of neurofibromatosis type 2 (NF2); both of them are known as risk factors for recurrence after surgical removal of spinal meningiomas. Considering this background of these two recurrences, the clinical results of the present study are consistent with previous results. Therefore, we propose that surgeons do not always have to achieve Simpson grade I removal if dural repair is complicated and postoperative cerebrospinal fluid (CSF) leakage or neurological worsening are estimated after resection of dural attachment and repair of dural defect.
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Neurol. Med. Chir. (Tokyo) · Jan 2014
Case ReportsSuccessful coil embolization of a ruptured basilar artery aneurysm in a child with leukemia: a case report.
Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. ⋯ The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms.
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Neurol. Med. Chir. (Tokyo) · Jan 2014
Third Ventriculostomy in Late-onset Idiopathic Aqueductal Stenosis Treatment: A Focus on Clinical Presentation and Radiological Diagnosis.
Endoscopic third ventriculostomy (ETV) is considered the gold standard treatment for obstructive hydrocephalus due to partial or complete obstruction of cerebrospinal fluid (CSF) ventricular pathways caused by mass lesions. However long-term efficacy of this procedure remains controversial as treatment of chronic adult hydrocephalus due to stenosis of Sylvian acqueduct [late-onset idiopathic aqueductal stenosis (LIAS)]. The authors describe clinical presentation, diagnostic investigations in patients affected by LIAS, and define their clinical and radiological outcome after ETV. ⋯ At follow-up a clinical improvement could be demonstrated in all cases. Selection criteria of LIAS patients seem to be crucial to obtain satisfactory and long-lasting results. Even in elderly patients with chronic hydrocephalus, ETV can be considered the treatment of choice.
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Neurol. Med. Chir. (Tokyo) · Jan 2014
Toxicity and outcome of radiotherapy with concomitant and adjuvant temozolomide in elderly patients with glioblastoma: a retrospective study.
Radiation therapy with concomitant and adjuvant temozolomide (TMZ) is the standard therapy for nonelderly patients with glioblastoma. However, TMZ-based chemoradiotherapy for elderly patients with glioblastoma is controversial. The aim of this study was to investigate the benefits and adverse effects of this combined therapy in elderly patients with glioblastoma. ⋯ TMZ-based chemoradiotherapy was associated with an increased risk of Grade 4 adverse events in the elderly patients during concomitant use. Thus, elderly patients who undergo a concomitant course of TMZ must be closely monitored for adverse events. Treatment of glioblastoma in elderly patients must be optimized to reduce toxicity to acceptable levels and to maintain efficacy.