Acta neurochirurgica
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Acta neurochirurgica · Feb 2005
Case ReportsSuccessful resection of a left insular cavernous angioma using neuronavigation and intraoperative language mapping.
Despite recent literature advocating the surgical removal of symptomatic Cavernous Angiomas (CA), even in critical brain areas, very few observations of insular CA surgery have been described, particularly in the left hemisphere. We report the case of a successful resection of a CA located in the dominant insula, using both neuronavigation and intra-operative functional mapping. This 33-year-old right-handed man harbored a left insular CA, revealed by generalized seizures following a bleed confirmed on MRI. ⋯ There was no postsurgical deficit, nor any seizure without treatment (follow-up: 4.5 years). The diagnosis of CA was confirmed by histological examination. Taking account of the risk of morbidity due to the natural history of CA, particularly in eloquent brain regions, we suggest to routinely consider the possibility of a surgical treatment in cases of symptomatic (left dominant) insular CA, using combined intra-operative anatomical and physiological localization methods.
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Acta neurochirurgica · Feb 2005
Case ReportsMultiple cystic cavernous angiomas associated with hemorrhage.
A 29-year-old man presented with impaired mental concentration and inability to remember. Magnetic resonance and computed tomography studies revealed multiple calcified cysts. ⋯ The histological diagnosis was cavernous angioma. The first report of multiple cystic cavernous angiomas is reported.
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Acta neurochirurgica · Feb 2005
Comparative StudySpinal epidural abscess: prognostic factors and comparison of different surgical treatment strategies.
Spinal epidural abscess (SEA) is a rare but potentially devastating disease requiring immediate surgical intervention and appropriate antibiotic treatment. The standard approach to decompress SEA is laminectomy. No report covers comprehensively the indications for the less invasive interlaminar approach, the usefulness of intra-operative ultrasonography and the suspected benefit of inserting a suction-irrigation drainage. ⋯ An interlaminar approach should be considered instead of laminectomy in lumbar SEA and in impending anterior column instability due to spondylitis. Intra-operative ultrasound is a beneficial aid for the determination of the extent of decompression during surgery and is practicable even through a narrow interlaminar bony window. The insertion of postoperative suction-irrigation drainage had no beneficial effect on outcome but bore the risk of epidural fluid congestion.
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Acta neurochirurgica · Feb 2005
Management of pituitary apoplexy: clinical experience with 40 patients.
Pituitary apoplexy is a rare major clinical event with neurological, neuro-ophthalmological, cardiovascular and hormonal consequences, resulting from an acute infarction of pituitary adenoma. We report our experience with a series of 40 patients presenting with pituitary apoplexy. ⋯ We present a large series of patients with pituitary apoplexy. Most subjects were operated, but six were treated conservatively. Almost all patients improved clinically, including those who were not operated, but hormonal deficiencies are very common.
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Acta neurochirurgica · Feb 2005
Clinical TrialTelovelar approach to the fourth ventricle: operative findings and results in 16 cases.
The cerebellomedullary fissure as a corridor for exposure of the fourth ventricle without vermian splitting is enjoying increasing application as a technique for exposure, to avoid the complications related to vermian splitting. The purpose of this study is to describe the operative findings and the results in 16 fourth ventricular tumours removed via telovelar approach. The impact of the pathological nature of the lesion on the degree of tumour removal is also discussed. ⋯ Despite the panoramic view provided by the telovelar approach, the pathological nature of the lesion and vital neural tissue infiltration are limiting factors for total tumour removal. Total removal of tumours focally attached to critical areas in the fourth ventricle should not be attempted at the expense of patient's morbidity and mortality. To achieve optimum outcome, near total excision is acceptable in cases where complete removal may endanger function or life.