Neurosurgery
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Aggressive fibromatoses are proliferations of fibrous tissue that infiltrate surrounding tissues and tend to recur after surgical resection. We report a series of five children with aggressive fibromatosis involving the cranial base. ⋯ Fibromatoses of the cranial base are rare and seem to be most common in the pediatric age group. Gross total resection, preferably in the first attempt, should be the goal. Radiotherapy and hormonal therapy are useful adjunctive methods for the treatment of aggressive fibromatosis. Fibromatoses that involve the cranial base are most likely to require a multidisciplinary treatment approach.
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Randomized Controlled Trial Comparative Study Clinical Trial
Thiopental and desflurane treatment for brain protection.
Thiopental produces cerebral metabolic depression and cerebral vasoconstriction. However, the effect of thiopental on brain tissue oxygen pressure (PO2), carbon dioxide pressure, and pH is not known. In a prospective study, we measured brain tissue gases and pH during thiopental or desflurane treatment that was administered for brain protection during brain artery occlusion. ⋯ Thiopental has a metabolically neutral effect on brain tissue gases and pH, even though it is known to decrease cerebral oxygen consumption. The metabolic depressant and vasodilator effects of desflurane enhance tissue oxygenation and attenuate tissue PO2 reductions produced by artery occlusion. Both thiopental and desflurane inhibit ischemic lactic acidosis and decreases in pH.
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The role of chemotherapy in the treatment of low-grade oligodendrogliomas and oligoastrocytomas is still unclear. A Phase II study was conducted to determine the benefits and toxicity of the procarbazine, lomustine, and vincristine (PCV) regimen in patients with low-grade oligodendrogliomas and oligoastrocytomas recurrent after surgery alone or surgery with radiotherapy. ⋯ These results suggest that chemotherapy with PCV is effective in the treatment of recurrent low-grade oligodendrogliomas and oligoastrocytomas.
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This study was conducted to determine whether a ventriculoperitoneal shunt alone was effective in treating subdural effusion with hydrocephalus. ⋯ Ventriculoperitoneal shunting alone is an effective and satisfactory procedure; no subdural peritoneal shunt is needed for patients with subdural effusion accompanied by hydrocephalus. To-and-fro communication between the subdural effusion and ventricles is considered to be present in these patients. When selecting the treatment for subdural effusion, it is important to consider whether hydrocephalus (disturbance of cerebrospinal fluid circulation) is present.
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Titanium aneurysm clips have superior imaging characteristics and have been supplanting their stainless steel counterparts. We report the case of a 36-year-old woman with a histologically demonstrated cell-mediated reaction to a cobalt alloy aneurysm clip. ⋯ Stainless steel surgical implants in the head can cause diffuse, severe pruritus in susceptible individuals. Although the role of the aneurysm clip, as opposed to the more superficial wires, in the genesis of the patient's symptoms is not certain, this case demonstrates that a cobalt alloy aneurysm clip can activate T cells and cause an immunological reaction in the central nervous system.