Journal of neurosurgery
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Journal of neurosurgery · Oct 2003
Case ReportsFracture of S1-2 after L4-S1 decompression and fusion. Case report and review of the literature.
The author describes a woman in whom an S1-2 fracture developed after L4-S1 decompression and fusion. Osteoporosis was not present, but the lesion failed to respond to conservative therapy, necessitating surgical extension of the spinal fusion. ⋯ To date, only four cases of sacral stress fracture appear in the literature, all involving female patients and reportedly associated with osteoporosis. Unlike the present case, the fracture resolved satisfactorily in all cases with conservative treatment.
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Journal of neurosurgery · Oct 2003
Case ReportsElectrical stimulation of the posterior subthalamic area for the treatment of intractable proximal tremor.
Tremors, including its proximal component, are often refractory to standard thalamic surgery. In the 1960s the posterior part of the subthalamic white matter was reported to be a promising target in treating various forms of tremor, but was also found to be associated with adverse effects. Advances involving a less invasive method, that is, deep brain stimulation (DBS), has led to a reappraisal of this target. ⋯ A characteristic diphasic pattern of SSEPs reaffirmed the electrophysiological endorsement of this target. Tremors, both proximal and distal, were remarkably improved in all patients. The rate of improvement, as indicated by the total tremor score, was a mean of 81%. Axial tremors in the legs and head were also improved. Most of the contacts associated with remarkable improvement were located in the posterior part of the subthalamic white matter (the zona incerta and prelemniscal radiation). Neither major complications nor neurological deterioration was observed. The authors concluded that DBS of the posterior part of the subthalamic white matter together with SSEP recording is a safe and effective method to ameliorate severe intractable tremors.
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Journal of neurosurgery · Oct 2003
Incidence of venous thromboembolism in patients undergoing craniotomy and motor mapping for glioma without intraoperative mechanical prophylaxis to the contralateral leg.
Evidence-based reviews support the use of venous thromboembolism (VTE) prophylaxis in the form of compression devices and/or stockings for patients undergoing craniotomy. In patients undergoing craniotomy with motor mapping for glioma, the contralateral lower extremity should remain visible so that motor responses can be accurately identified. As a consequence, these patients could be placed at a higher risk to develop VTE. The authors have quantified the incidence of VTE in patients undergoing craniotomy with motor mapping and have shown that there is no increased risk of developing a VTE in the contralateral lower extremity when compression devices are not used. ⋯ The incidence of VTE in patients undergoing craniotomy with motor mapping is comparable to that in patients receiving bilateral lower-extremity mechanical VTE prophylaxis. The practice of leaving the contralateral lower extremity free from intraoperative prophylaxis does not appear to place patients at a higher risk for developing VTE. There appears to be no preferential distribution of VTE in contralateral lower extremities that do not receive immediate preoperative and intraoperative mechanical prophylaxis.
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Journal of neurosurgery · Oct 2003
Comparative StudyOne-level one-sided lumbar disc surgery with and without microscopic assistance: 1-year outcome in 114 consecutive patients.
The aim of this study was to compare the outcomes following macrodiscectomy and microsurgery for one-level one-sided lumbar disc excision. ⋯ Microdiscectomy allows the surgeon good visualization and is less traumatic to the involved tissues. Interestingly, the results of this study indicated that microsurgery does not reduce hospitalization time, nor does it improve the overall surgery-related outcome. The main differences between the two procedures were length of the incision and operative time. The author found that lumbar microdiscectomy allows patients earlier return to work and/or normal life with less reliance on postoperative narcotic analgesic agents.
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Journal of neurosurgery · Oct 2003
Case ReportsSpinal intradural extramedullary cavernous angioma. Case report.
The spinal intradural extramedullary cavernous angioma is a rare clinical entity. Only 20 surgically treated cases have been reported. ⋯ Intradural extramedullary cavernous angiomas occur predominantly in males, in the lower thoracolumbar region, exhibit a relatively high association with subarachnoid hemorrhage, and mostly adhere to the nerve root or spinal cord. Because resection is possible without causing morbidity and because outcome depends on the severity of preoperative neurological dysfunction, precise diagnosis and timely treatment are mandatory.