Neurosurgery
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Review Case Reports
Remote cerebellar hemorrhage after a spinal surgery complicated by dural tear: case report and literature review.
This report presents a case in which cerebellar hemorrhage occurred after lumbar decompression surgery that was complicated by dural tear and prolonged cerebrospinal fluid leakage. Remote cerebellar hemorrhage after spinal surgery is extremely rare. Our objective is to describe this unusual complication, discuss the possible mechanisms of remote cerebellar hemorrhage, and review the literature. ⋯ Although it is an extremely rare complication, remote cerebellar hemorrhage should be kept in mind as a possible complication of spinal surgery, especially in operations complicated by dural tears.
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Arteriovenous malformations are a heterogeneous group of intra-axial central nervous system vascular lesions consisting of tangles of abnormal arteriovenous connections without intervening capillary beds. The heterogeneity of arteriovenous malformations is described by the Spetzler-Martin grading scale, a scale that also forms the basis for clinical decision making. The microsurgical treatment of appropriately selected supratentorial arteriovenous malformations is based on the tenets of circumferential isolation and transection of arterial feeders, preservation of vessels en passant and surrounding functional neural tissue, and skeletonization and transection of venous drainage.
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Not infrequently, patients with bilateral cerebral aneurysms are encountered. In such patients, the ability to treat bilateral aneurysms through a unilateral approach spares the patient the risk and inconvenience associated with a separate craniotomy. The contralateral approach for aneurysm repair is technically feasible and safe in appropriately selected patients. Herein, we review our technique for maximizing contralateral exposure and clipping contralateral aneurysms through the four anatomic triangles that serve as corridors in this approach.
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Comparative Study Clinical Trial
Gravitational shunts in longstanding overt ventriculomegaly in adults.
A new entity of chronic hydrocephalus was introduced recently in the international literature: longstanding overt ventriculomegaly in adults. Previous experience with this disorder has demonstrated that shunt therapy for such patients involves a considerable risk of overdrainage. In the present study, we aimed to clarify whether this risk could be avoided by use of gravitational shunts. ⋯ Unlike conventional differential pressure shunts, gravitational shunts can be used in the treatment of high-risk patients with longstanding overt ventriculomegaly in adults. Significant risk of overdrainage can be avoided. Gravitational shunts offer a viable alternative to endoscopic third ventriculostomy, provided the choice and adjustment of the shunt opening pressure is based on a correct assessment of the hydrostatic pressure to be compensated for.
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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.