Acta neurochirurgica
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Acta neurochirurgica · Jan 2000
Permanent postoperative anosmia: a serious complication of neurovascular decompression in the sitting position.
In posterior fossa surgery, the sitting position offers a number of advantages believed to outweigh complications such as air embolism and pneumatocephalus. For this reason, the sitting position is frequently used in neurovascular decompression for trigeminal neuralgia. Two years ago we reported on a previously undescribed complication: permanent postoperative anosmia. ⋯ Permanent postoperative anosmia following surgical procedures in the sitting position has been observed in 3 other institutions. In addition, the survey revealed that only 40% of German neurosurgeons still favor the sitting position for surgery of the posterior cranial fossa. Considering that permanent anosmia severely reduces quality of life, and that it can be avoided by using another position, the sitting position for surgical procedures in the posterior fossa should be restricted to special cases (e.g., brain stem tumors).
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Acta neurochirurgica · Jan 2000
Intra-operative mapping of the motor cortex during surgery in and around the motor cortex.
The intra-operative use of neurophysiological techniques allows reliable identification of the sensorimotor region, and constitutes a prerequisite for its anatomical and functional preservation. The present prospective study combines monopolar cortical stimulation (MCS) with the recording of phase reversal of somatosensory evoked potentials (SEP-PR) in a protocol for the intra-operative mapping of the motor cortex. Functional mapping of the motor cortex by SEP-PR and MCS was performed in 70 patients during surgery in and around the motor cortex. ⋯ In 3 cases no MEP was recorded, not even after maximal stimulation intensity, the central sulcus being localized by SEP-PR only. On the other hand, MCS allowed localizing the motor cortex in the 2 cases with no recordable SEP-PR. Thus, combining SEP-PR and MCS allowed intra-operative localization of the sensorimotor cortex in 100% of the cases.
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Acta neurochirurgica · Jan 2000
Review Case ReportsPure acute subdural haematoma without subarachnoid haemorrhage caused by rupture of internal carotid artery aneurysm.
A 52-year-old female presented with disturbance of consciousness and clinical signs of tentorial herniation. Computed tomography showed a pure acute subdural haematoma (SDH) over the left convexity without subarachnoid haemorrhage. Cerebral angiography showed a saccular aneurysm at the junction of the left internal carotid artery and the posterior communicating artery. ⋯ Rupture of an aneurysm adhered to either the dura or falx and located in the subdural space may cause pure SDH. Therefore, ruptured intracranial aneurysm should be considered as a cause of non-traumatic SDH. Immediate removal of the SDH and aneurysmal clipping is recommended in such patients, even those in poor neurological condition.
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Brain stem epidermoid cysts are extremely rare. We describe an unusual case of prepontine epidermoid cyst with a large part of the tumour insinuating itself into the pons. ⋯ Cases reported in the literature either had high mortality/morbidity or were only subtotally removed. Relevant literature is reviewed.