Neurosurgery
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Fibrous hamartoma of infancy (FHI) in the spinal cord is very rare. It is characterized histopathologically by three elements: fibrous, adipose, and myxoid mesenchymal tissues. ⋯ FHI in the central nervous system, especially in the spine, is very rare, and the presence of glial tissue admixed with particular components of FHI is quite exceptional.
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Case Reports
Distal lenticulostriate artery aneurysm rupture presenting as intraparenchymal hemorrhage: case report.
Aneurysms involving the distal lenticulostriate artery branches are a rare cause of spontaneous intracerebral hemorrhage. We report a case of ruptured lenticulostriate aneurysm in an otherwise healthy patient and review the literature on this topic. ⋯ Although intraparenchymal hemorrhages are fairly common, the underlying vascular abnormality is rarely identified. Most are related to hypertensive vascular degeneration, rupture of a Charcot-Bouchard aneurysm, or both. When intracerebral hemorrhage occurs in young patients, however, aggressive investigation is warranted to rule out a structural vascular abnormality.
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Craniocerebral aspergillosis of sinonasal origin has been reported mainly in immunocompromised patients with high mortality, and it has been described very infrequently in immunocompetent hosts. This retrospective study focuses on clinical outcome in relation to anatomic locations of invasive aspergillosis of sinonasal origin in immunocompetent patients with emphasis on our preliminary experience with use of preoperative orally administered itraconazole. ⋯ Craniocerebral aspergillosis in immunocompetent hosts has three patterns of presentation that seem to correlate with clinical outcomes. Intracerebral aspergillosis (Type 1) is associated with the worst clinical outcome. Patients with orbital and cranial base aspergillosis (Type 3) had good recovery. Intracranial extradural aspergillosis (Type 2) remained intermediate on the Glasgow Outcome Scale. Preoperative orally administered itraconazole therapy may improve clinical outcome in patients with intracerebral aspergillosis. Prospective clinical studies are required to make firm clinical therapeutic recommendations.
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Changes in neurosurgical workload can justify requests for hospital resources and guide planning by neurosurgical training programs. Most previous studies have used non-population-based data sources, such as surveys of professional society members, to explore the neurosurgical workload in the United States. ⋯ We documented an increase in total caseload and centralization of care for DRG 1 in the United States during the period 1988 to 2001. Defining the reasons for the changes in neurosurgical workload we observed will require further research.
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Thrombolytic agents have been administered through external ventricular drains to treat intraventricular hemorrhage, the goals being to accelerate clot clearance, prevent catheter obstruction, and help control intracranial pressure. We compared these variables in a group of aneurysm patients treated by one surgeon who routinely used intraventricular recombinant tissue plasminogen activator (rt-PA) for obstructive hematocephalus with those in a group of similar patients treated by other surgeons who did not. ⋯ Intraventricular thrombolysis with rt-PA seems to assist in the acute management of patients with large aneurysmal intraventricular hemorrhages, speeding clearance of aneurysmal intraventricular hemorrhage, normalizing intracranial pressure, and reducing ventricular catheter obstruction. A randomized trial is needed to confirm these findings, establish treatment safety, and determine whether treatment affects outcome.