Zentralblatt für Neurochirurgie
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Zentralbl. Neurochir. · Aug 2008
Case ReportsSpinal cord compression by an arachnoid cyst: a case report and review of the literature.
Intradural extramedullary cysts are a rare cause of spinal cord compression. We present a case with slowly progressive radicular pain and gait disorder over several years, due to medullary compression by a giant cervico-thoracic arachnoid cyst. ⋯ This case report, together with a review of the literature, shows the extreme adaptability of the human spinal cord, in cases of slowly progressive compression.
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Zentralbl. Neurochir. · Aug 2008
Randomized Controlled Trial Comparative StudyRandomized comparative study of burr-hole craniostomy versus twist drill craniostomy; surgical management of unilateral hemispheric chronic subdural hematomas.
Although there is a tendency to minimize the surgical procedures for chronic subdural hematomas, there is no agreement on the optimal treatment. In the literature there is only one published result of a randomized study comparing twist drill craniostomy with burr-hole craniostomy. We aimed to compare twist drill craniostomy with burr-hole craniostomy for the treatment of unilateral hemispheric chronic subdural hematomas in adults. ⋯ Both surgical methods seem effective for the treatment of unilateral chronic subdural hematomas.
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Zentralbl. Neurochir. · Aug 2008
Accuracy and distortion of deep brain stimulation electrodes on postoperative MRI and CT.
Postoperative monitoring of the electrode position is important to evaluate the best stimulation site in deep brain stimulation. MR imaging is excellent for ruling out postoperative complications e.g. haemorrhage, but its accuracy in electrode localisation is still controversial. The reasons for this are the size of the artefact around the electrode and its unclear relation to the electrode position (concentric or eccentric). The goal of this study was to determine the relation and size of these artefacts to the electrodes by comparing the position of the electrodes in postoperative MR and CT imaging. ⋯ The size of the electrodes' artefact was smaller on CT compared to MR. Furthermore, the position was not precisely concentric around the electrode. Nevertheless, the mean deviation after measuring the contact position in both CT and MR was less than 1 mm in all three planes. Both techniques are eligible for postoperative localisation of DBS electrodes, with a small imprecision of the non-stereotactic MR compared to the stereotactic CT. This might be compensated by the fact that postoperative MR can rule out asymptomatic postoperative complications e.g. haemorrhages or infarctions, without radiation exposure of the patient.
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Zentralbl. Neurochir. · Aug 2008
Case ReportsBilateral trigeminal neuralgia and charcot-marie-tooth disease: diagnosis and successful microsurgical treatment of bilateral neurovascular compression.
The association of Charcot-Marie-Tooth (CMT) disease and trigeminal neuralgia (TN) is rare. CMT and bilateral TN is even rarer. Our literature review has revealed only 4 previous cases with CMT and bilateral TN. We report the case of a 23-year-old man with a prior diagnosis of CMT and unilateral deafness who initially presented with excruciating and lancinating right-sided facial pain. ⋯ The underlying neuropathy in CMT makes the trigeminal nerve more vulnerable to vascular compression than usual. The bilateral compression of the trigeminal nerve-pons junction in our patient suggests that the external pressure probably adds to the internal defects in central myelin formation, structure or maintenance. Nevertheless, the mid-term follow-up after MVD clearly shows that the causal treatment for TN can be successfully applied to patients with TN plus CMT.
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Zentralbl. Neurochir. · May 2008
Predictive value of intrathecal interleukin-6 for ventriculostomy-related Infection.
Early diagnosis of ventriculostomy-related infection (VRI) is crucial for the early treatment and course of this disease. In neurosurgical patients the diagnostic criteria are equivocal, mostly because of bloodstained cerebrospinal fluid (CSF). The predictive value, sensitivity and specificity of intrathecal interleukin-6 (IL-6 (CSF)) has been proven for VRI compared with classical diagnostic CSF parameters, i.e. cell countCSF (CC (CSF)) and total protein (CSF). ⋯ Our data indicate that IL-6 (CSF) is a reliable marker for predicting VRI prior to clinically manifest meningitis, one day earlier than the common diagnostic criteria of CSF infection (CC (CSF), total protein (CSF), clinical symptoms).