Acta neurochirurgica
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Acta neurochirurgica · Nov 2009
Review Case ReportsRecovery from paraplegia after the treatment of spinal dural arteriovenous fistula: case report and review of the literature.
Spinal dural arteriovenous fistula (SDAVF) is a rare and enigmatic disease. Functional outcome is particularly uncertain for the small group of patients that are unable to stand at the time of diagnosis (grade 5 gait disturbance on the Aminoff-Logue scale, ALS). The objective of this study is to examine the final functional outcome of patients with SDAVF in grade 5 gait ALS before treatment. ⋯ Interruption of SDAVF in paraplegic patients may improve the final functional gait outcome in some cases. No complete recovery (grade 0 gait ALS) was achieved after treatment. Micturition disturbances had a worse prognosis than motor deficits.
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Acta neurochirurgica · Aug 2009
ReviewHemostatic and hemorrhagic problems in neurosurgical patients.
Abnormalities of the hemostasis can lead to hemorrhage, and on the other hand to thrombosis. Intracranial neoplasms, complex surgical procedures, and head injury have a specific impact on coagulation and fibrinolysis. Moreover, the number of neurosurgical patients on medication (which interferes with platelet function and/or the coagulation systems) has increased over the past years. ⋯ Perturbations of hemostasis can be multifactorial and maybe encountered in the daily practice of neurosurgery. Early diagnosis and specific treatment is the prerequisite for successful treatment and good patients outcome.
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Having just celebrated the centenary of the first transsphenoidal pituitary operation by (Schloffer in Austria in Beitr Klin Chir 50:767-817, 1906), and this year the quarter centenary of the first published report of a therapeutic use of the neuroendoscope (for colloid cysts of the third ventricle) (Powell et al. in Neurosurgery 13:234-237, 1983), it is time to consider the relative merits of microscopic and endoscopic approaches for pituitary surgery. Although transsphenoidal endoscopic surgery has only been utilised by pioneers such as Jho since the mid-1990s (Jho et al., 1996), there is no doubt that it has already gained an important place in the neurosurgical armamentarium, but there is both confusion and propaganda about which method of surgery has most to offer, and indeed whether or not there is any real difference at all.
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Acta neurochirurgica · Mar 2009
Review Case ReportsKlippel-Feil syndrome in association with posterior fossa dermoid tumour.
Klippel-Feil syndrome (KFS) is characterized by specific congenital anomalies of segmentation of the cervical spine. On the other hand, dermoid tumour is a rare entity accounting for 0.04-0.7% of all intracranial tumours and the most common location is in the posterior fossa, at or near the midline. ⋯ The experience prompted me to review reports in the literature since 1936 of posterior fossa dermoid tumour associated with KFS. From my analysis, I highlight early diagnosis and an appropriate surgery to prevent complications such as neural compression and bacterial or aseptic meningitis through the rupture site or dermal sinus in cases of KFS associated with for dermoid tumours of the posterior fossa.
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Acta neurochirurgica · Mar 2008
ReviewVarious surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes.
The literature contains many varying, often conflicting surgical results. However, there is no study comparing long-term effectiveness of all surgical procedures for trigeminal neuralgia (TN). The aim of the present analysis is to report the long-term outcomes of surgical options of TN since the development of electronic databases, to evaluate them with the same clinical and statistical criteria and determine the most appropriate treatment. ⋯ The study suggests that each surgical technique for treatment of trigeminal neuralgia has merits and limitations. However, MVD provides the highest rate of long-term patient' satisfaction with the lowest rate of pain recurrence.