Neurosurgery
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Case Reports Comparative Study
Neural damage caused by cerebral hyperperfusion after arterial bypass surgery in a patient with moyamoya disease: case report.
The prognosis of cerebral hyperperfusion syndrome after vascular reconstructive surgery, including extracranial-intracranial arterial bypass, is not poor unless intracerebral hemorrhage develops secondary to hyperperfusion. ⋯ The current case suggests that cerebral hyperperfusion after vascular reconstructive surgery can cause irreversible neural damage, which results in cognitive impairment.
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Arteriovenous malformations in the cranial nerves are very rare, and only one case has been reported in the literature. To our knowledge, this is the first case report of an arteriovenous malformation in the auditory nerve. ⋯ Although arteriovenous malformations are thought to arise in the 4th to 8th weeks of gestation, this case might indicate a more specific time of emergence based on embryogenesis of the cranial nerves.
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Comparative Study
Hemangioblastomas of central nervous system: molecular genetic analysis and clinical management.
Hemangioblastomas of the central nervous system (CNS) are benign neoplasms that may occur sporadically or in association with von Hippel-Lindau (VHL) disease. The proportion of primary symptomatic hemangioblastomas associated with VHL disease is estimated to be from 10 to 40%, but it seems to be underestimated. We investigated the frequency of VHL germline mutation in patients with symptomatic CNS hemangioblastoma without evidence of VHL disease to define the role of molecular genetic analysis in the management of such patients and their relatives. ⋯ Molecular genetic analysis is a safer and more specific instrument to confirm or exclude VHL disease in patients with CNS hemangioblastoma, a negative family history, or absence of other known manifestations of the disease. Early identification of VHL mutation gene carriers is important for reducing disease morbidity and mortality. Nonsymptomatic family members will benefit from early VHL disease diagnosis or by being excluded as at-risk subjects, reducing the psychological and economic burden of screening and surveillance protocols.
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Comparative Study Clinical Trial
Results of transsphenoidal surgery in a large series of patients with pituitary adenoma.
To report the efficacy and safety of microsurgical transsphenoidal surgery in a series of previously untreated patients with pituitary adenoma. ⋯ Transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first-choice therapy in all cases except for prolactinomas responsive to dopamine agonists. Other treatment methods, such as radiotherapy, stereotactic radiosurgery, and medical therapy, play an important role in patients not cured by surgery.
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To study the hyperacute histological and immunohistochemical effects of stereotactic proton beam irradiation of the rat hippocampus. ⋯ DNAF, a marker of cell death, was present in rat hippocampi within 5 hours of delivery of cobalt-2 Gray equivalents stereotactically focused irradiation, suggesting that even low-dose radiosurgery has hyperacute neurotoxic effects. Activated mitogen-activated protein kinase was incompletely colocalized with DNAF, suggesting that activation of this cascade is neither necessary nor sufficient to initiate acute cell death after irradiation.