Neurosurgery
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Historical Article
New World cranial deformation practices: historical implications for pathophysiology of cognitive impairment in deformational plagiocephaly.
Throughout history, prehistoric and even some contemporary civilizations have practiced various forms of intentional and unintentional cranial deformation. Plagiocephaly can be the result of craniosynostosis, infant positioning, or other unintentional or intentional deformation. ⋯ Because we can only view these cultures through the relics of time, any conclusions one might draw from the anthropological and historical record regarding the cognitive effects of head deformation can only be inferred through generalized observations and are tenuous. Nevertheless, there does not seem to be any evidence of negative effect on the societies that have practiced even very severe forms of intentional cranial deformation (e.g., the Olmec and Maya). On the other hand, the physical anthropology and the contemporary developmental literature suggest possible mechanisms for such an effect.
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The aim of this study was to investigate the microsurgical results of symptomatic sacral perineurial cysts of 11 patients and to discuss the treatment options of the past 10 years. ⋯ Microsurgical treatment yielded the best long-term resolution of patient symptoms to date and should be recommended to appropriately selected patients.
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Surgical treatment may be required for large petroclival meningiomas; however, surgery for these lesions is a major undertaking, and modern surgical approaches are still associated with considerable morbidity and recurrence rates. We analyzed our series of transpetrosally operated petroclival meningiomas to obtain detailed information regarding the surgery outcomes with respect to facial nerve effects, hearing changes, general neurological and psychosocial differences, and recurrence rates to identify opportunities for improvement. ⋯ Generally, outcomes compared well with current reports. Outcomes can be improved, however by improving patients' psychosocial support; striving to decompress, preserve, and minimize dissection of ill-defined planes of cranial nerves; and using Simpson Grade 4 gamma knife approaches when radicality is precluded. Currently, the performance of transpetrosal surgery for petroclival meningiomas is a major undertaking that significantly affects a patient's health for several years; however, the approaches that we used allowed a high degree of tumor control with relatively little neurological morbidity.
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Although relevant information exists regarding the chance of obliterating arteriovenous malformations (AVMs) using radiosurgery, the overall chance of cure after gamma knife radiosurgery is usually only extrapolated from a portion of all monitored patients. This chance and the risks involved in radiosurgery, including repeat treatment when necessary in a defined population of treated patients, were analyzed in our study. ⋯ Although one-quarter of the patients required that the treatment be repeated, gamma knife radiosurgery can offer a high cure rate for patients treated for AVMs with a low risk of morbidity and mortality from rebleeding during the latent period.
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The cerebellopontine angle (CPA) is a rare location for an arachnoid cyst. We describe a patient with a CPA arachnoid cyst who presented with hoarseness (unilateral vocal cord paralysis) and dysphagia secondary to isolated compression of the vagus nerve. This rare presentation of a CPA arachnoid cyst has not been reported previously. ⋯ Postoperatively, the patient's dysphagia completely resolved. However, the results of a laryngeal electromyocardiogram revealed minimal evidence of recovery in the affected vocal fold, and the patient continued to suffer from dysphonia. Although CPA arachnoid cysts are rare, they should be considered when a patient presents with an isolated cranial nerve palsy. Treatment options include cyst fenestration and cranial nerve decompression.