Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Sep 2013
Relaxing incision of nostril sill to expand the transnasal transsphenoidal approach: technical note.
The transsphenoidal approach to the pathology of sellar region is a fundamental procedure in the armamentarium of neurosurgeons. Modern practice tends to prefer various transnasal approaches over the more traditional sublabial route. However, the transnasal approach can be limited by small nares, particularly in the pediatric population. ⋯ In our experience, the relaxing incision significantly expands the transnasal corridor and allows easy placement of the self-retaining nasal speculum or endoscopic instruments, is well tolerated by patients, and heals with no cosmetic concerns.
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Clin Neurol Neurosurg · Sep 2013
Nonoperative management of odontoid fractures: a review of 59 cases.
Surgical treatment of odontoid fractures is recommended by many surgeons to prevent sudden neurologic injury or progressive myelopathy. Less aggressive approach to the treatment of odontoid fractures has been advocated by some authors especially in the elderly population. Very few reports have followed up patients' outcomes following conservative treatment of odontoid fractures. Here we evaluate the clinical and radiographic results of patients without myelopathy treated without surgery for an odontoid type fracture. ⋯ Our results indicate that a select group of patients with odontoid fracture who are deemed stable on initial evaluation in a cervical orthosis may be effectively managed non-operatively. None of the patients who were managed conservatively had clinical worsening during the period of management. The decision to proceed with surgical treatment was based on failure of resolution of neck pain or worsening or concerning instability on imaging studies. However in many patients, even elderly patients in a surgical risks are greater, many odontoid fractures can be safely managed in a cervical orthosis.
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Migraine is common in pediatric neurology practice, while migraine variants are rare and pose diagnostic problems. ⋯ Basilar type migraine was the most common migraine variant. ACM and AWS should be regarded as distinct entities in the ICHD as migraine with complex aura. Benign paroxysmal torticollis also deserves its place as a migraine variant. Cases of ophthalmoplegic migraine with spontaneous remission and no cranial nerve enhancement on MRI should be considered as migraine form. Analyzing migraine variants will contribute to better awareness and adequate diagnosis.