Neurosurgery
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Review Case Reports
Lateral sacral artery aneurysm: case report and review of the literature.
We report the third case of an aneurysm of the lateral sacral artery (AnLSA). In all cases, because of an incorrect preoperative diagnosis, the surgeons were confronted with severe and unexpected hemorrhaging, and surgery was aborted without effective treatment. Our purpose is to present the preoperative features of AnLSA and its treatment modalities. ⋯ A medical history of renal transplantation with MRI scans showing an anterior epidural mass behind S1 or a spontaneous spinal epidural hematoma are features that must evoke a diagnosis of AnLSA. Treatment is mandatory and is best achieved by embolization. Surgery based on angiographic findings is indicated if the lesion is responsible for a compressive hematoma.
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The clinical and radiographic presentations of optic nerve gliomas and optic neuritis are for the most part distinct and their diagnoses straightforward. We present two cases illustrating the occasional difficulty one can encounter in distinguishing neoplastic from inflammatory optic neuropathies. ⋯ Differentiating between optic nerve neoplasm and inflammation may be difficult. On occasion, the classic clinical finding of pain with eye movement and the radiographic finding of enlargement and enhancement of the optic nerve may be misleading. Open biopsy of the optic nerve is indicated only after a completely negative metabolic, infectious, and inflammatory workup; interval increase of the optic nerve on magnetic resonance imaging; and failure of the patient to recover vision.
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Comparative Study Clinical Trial
Facial and cochlear nerve function after surgery of cerebellopontine angle meningiomas.
Meningiomas of the cerebellopontine angle (CPA) share a common location, but their site of dural origin and their relationship to surrounding neurovascular structures of the CPA are variable. The clinical presentation and outcome after surgical resection are different because of the diversity of this tumor entity. We report on a series of 421 patients with CPA meningiomas, with special emphasis on the analysis of the preoperative and postoperative facial and cochlear nerve function in relation to the site of dural attachment and main tumor location in the CPA cistern. ⋯ Although the outcome of facial and cochlear nerve function is different in CPA meningiomas, depending on the topographic classification of these tumors, preservation of the cochlear nerve is possible in every tumor group and should be attempted in every patient with CPA meningioma. It has to be kept in mind that recovery of hearing was also observed in patients with preoperative profound hearing deficits.
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Comparative Study Clinical Trial
Comparison of conventional region of interest and statistical mapping method in brain single-photon emission computed tomography for prediction of hyperperfusion after carotid endarterectomy.
Hyperperfusion after carotid endarterectomy (CEA) has been proposed as the main mechanism of intracerebral hemorrhage, which is a disastrous complication. The aim of this study was to compare the predictive value of cerebral blood flow (CBF) abnormalities for hyperperfusion after CEA with the conventional region of interest (ROI) analysis and statistical brain mapping analysis. ⋯ Objective assessment of CBF status, especially baseline CBF reduction (z-score), with automatic quantification by 3-D-SSP with normalization had a higher diagnostic value than conventional ROI analysis to identify patients at risk for hyperperfusion after CEA.
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Although spontaneous intracranial hypotension (SIH) is an increasingly recognized syndrome, the long-term outcomes have not been established. We conducted a long-term follow-up study to clarify the clinical features and long-term outcomes of patients with this disorder. ⋯ In this series, the outcome of SIH after conservative treatment was not as satisfactory as that reported in previous studies. We conclude that periodic follow-up examinations must be performed and a more effective treatment modality developed to achieve complete resolution of SIH.