Neurosurgery
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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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Although an autogenous saphenous vein is frequently used as a bypass graft, an aneurysm of a venous graft is a rare complication, especially in the case of cerebrovascular revascularization. We report a case of a successfully treated aneurysmal change in a venous graft after short vein bypass grafting. ⋯ The aneurysm seemed to have developed in a curved segment because of hemodynamic stress.
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When using the median infratentorial supracerebellar approach, all or numerous bridging veins over the cerebellar surface must be sacrificed. Such sacrifice potentially causes cerebellar venous infarction, especially when excessive cerebellar retraction is applied. To prevent such potential complications, neurosurgeons must have adequate knowledge of the anatomy of the bridging veins, particularly the hemispheric bridging veins. ⋯ Anatomic familiarity with the bridging veins can minimize their intraoperative sacrifice and avert subsequent postoperative complications. This knowledge also assists in planning the best approach to the pineal region.
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To evaluate the surgical findings and subsequent therapeutic implications of posterior fossa reexploration for persistent or recurrent trigeminal neuralgia (TN) or hemifacial spasm (HFS) after failed microvascular decompression (MVD). ⋯ Recurrent vascular compression was seldom identified during posterior fossa reexploration for failed MVD in patients with persistent or recurrent TN or HFS. The previously placed Ivalon sponge or Teflon implant was consistently found to be in good position. Partial sensory trigeminal rhizotomy is an often effective alternative in cases of recurrent TN when neurovascular compression is not identified. However, because of the relatively high incidence of complications associated with reexploration, we recommend other ablative or medical treatments for most patients after failed MVD for TN or HFS.
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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.