Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsAcute decompensation of noncommunicating hydrocephalus caused by dilated Virchow-Robin spaces type III in a woman treated by endoscopic third ventriculostomy: a case report and review of the literature.
Even though dilated Virchow-Robin spaces (VRS) are a very rare entity, they can compel the clinician to start immediate intervention in the case of acute onset of symptoms. To allow a well-balanced management decision, we compiled a summary of all cases published in the literature and discuss the different methods and indications for neurosurgical intervention in relation to dilated VRS. ⋯ To the best of our knowledge, the case presented here is the first case of acute decompensation of a noncommunicating hydrocephalus caused by dilated VRS. Neurosurgical intervention is required in cases of noncommunicating hydrocephalus caused by giant tumefactive VRS. The treatment options are mono- or biventricular shunt surgery or ETV. Because ETV provides the possibility of cyst fenestration and membrane sampling, it appears to be the most advantageous treatment option.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsA variation of the cords of the brachial plexus on the right and a communication between the musculocutaneous and median nerves on the left upper limb: a unique case.
During routine anatomical dissection of the upper extremity of a 64-year-old cadaver for educational purposes, we observed variations in the brachial plexus on each side. On the right an anomaly of cord formation was present and on the left there was a communication between the musculocutaneous nerve (MCN) and median nerve (MN). On the right side the brachial plexus showed two trunks, superior (C5 and C6) and inferior (C7, C8, and T1); the middle trunk was absent. ⋯ This communicating branch also gave rise to a muscular branch to the brachialis muscle and the lateral cutaneous nerve of forearm. No additional heads of the biceps brachii muscle were observed in either upper limb. Knowledge of the variations of the brachial plexus in humans can be valuable for operations of the shoulder joint and its repair for providing an effective block or treatment for anesthetists and also for explaining otherwise incomprehensible clinical signs for neurologists.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsGigantism treated by pure endoscopic endonasal approach in a case of McCune-Albright syndrome with sphenoid fibrous dysplasia: a case report.
McCune-Albright syndrome (MAS) is an uncommon polyostotic manifestation of fibrous dysplasia in association with at least one endocrinopathy that is mostly associated with precocious puberty and hyperpigmented skin macules named café-au-lait spots. We present an atypical manifestation of McCune-Albright syndrome in a 19-year-old man with the uncommon association of polyostotic fibrous dysplasia and gigantism in the absence of café-au-lait spots and precocious puberty. ⋯ Magnetic resonance imaging (MRI) found a right stalk shift of the pituitary with a 20 mm pituitary adenoma. We describe the diagnostic and endoscopic endonasal transsphenoidal approach for excision of the tumor.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsPial arteriovenous fistula as a cause of bilateral thalamic hyperintensities--an unusual case report and review of the literature.
Isolated bilateral thalamic congestion due to an arteriovenous malformation (AVM) is a rare entity. Few case reports of dural arteriovenous fistula associated with it have been reported in the literature. The association of pial arteriovenous fistula (pial AVF) with thalamic hyperintensities has never been described before. The pial AVF is a recently recognized lesion in which the multiple pial arterial feeders drain into a single venous channel without a nidus like in conventional AVM. In spite of being congenital in origin, these lesions may have expression in adulthood due to abrupt change in the venous drainage system. Successful management of pial AVF associated with bilateral thalamic hyperintensities is described here with review of the literature. ⋯ Strong suspicion of vascular malformation as a cause of bilateral thalamic hyperintensities helps in early detection. Such lesions like pial AVF presented here require active intervention by surgery or endovascular therapy. GKT is an important adjuvant in lesions refractory to either of them.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsSimultaneous rupture of two middle cerebral artery aneurysms presented with two aneurysm-associated intracerebral hemorrhages.
Simultaneous rupture of more than one intracranial aneurysm is a rare event and difficult to diagnose. In this case report, we present the case of a patient with a simultaneous rupture of two middle cerebral artery (MCA) aneurysms with two separately localized aneurysm-associated intracerebral hemorrhages (ICH). Initially, the patient presented with headache and neck stiffness as well as progressive decrease of consciousness. ⋯ Rupture of both aneurysms was confirmed during surgery, and both aneurysms were clipped microsurgically without complications. Although rupture of one aneurysm in patients with multiple aneurysms is the most common event, this case indicates that simultaneous rupture should be kept in mind in patients with multiple aneurysms. In patients with multiple aneurysms, the identification of the ruptured aneurysm(s) is necessary to avoid leaving a ruptured aneurysm untreated.