Neurosurgery
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Trochlear nerve neuromas are extremely rare. Seventeen surgical cases of this pathological condition have been reported in the English literature. The presented case is distinct from previous reports. ⋯ The facial pain resolved immediately after surgery. Although facial dysesthesias have been noted among patients with trochlear nerve neuromas, here the atypical facial pain was the only clinical manifestation. In all previously reported cases, neuromas originated from the cisternal segment of the trochlear nerve (always before the site of nerve entrance into the tentorial leaves) and expanded mainly into the prepontine and interpeduncular cisterns. Subtemporal and suboccipital approaches were used. In this case, the tumor arose from the short segment of the nerve running between the tentorial leaves. The tumor did not extend either into the ambient cistern or into the cavernous sinus but did involve the parasellar area. A pterional approach was appropriate for tumor removal. A trochlear nerve neuroma should be considered as a potential cause of atypical facial pain.
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Three-dimensional (3-D) ultrasound is an intraoperative imaging modality used in neuronavigation as an alternative to magnetic resonance imaging (MRI). This article summarizes 4 years of clinical experience in the use of intraoperative 3-D ultrasound integrated into neuronavigation for guidance in brain tumor resection. ⋯ Intraoperative 3-D ultrasound seems to provide a time- and cost-effective way to update high-quality 3-D maps used in neuronavigation.
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Although surgeons in Austria, especially in Vienna, were counted among the leading specialists at the end of the 19th century, neurosurgery did not evolve as a distinct discipline before the turn of the century; achievements were episodic until Anton von Eiselsberg became an enthusiastic surgeon of the central nervous system at the beginning of the 20th century. On the threshold of modern microneurosurgery, he was succeeded in Vienna by Leopold Schönbauer and then by Herbert Kraus. Although Schönbauer kept a certain distance from neurosurgery before World War II, a special department of neurosurgery was founded at the University of Graz Medical Faculty in 1950. ⋯ At present, Austria harbors three university departments of neurosurgery (Vienna, Graz, and Innsbruck) and three more departments at community hospitals, in addition to four at state hospitals. Each is equipped with modern devices, including the capacity for radiosurgery in five institutions. In 1954, a scientific society was founded, but neurosurgery was not established as a distinct specialty in medicine in Austria until 1976.
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Review Case Reports
Ectopic recurrence of craniopharyngioma after an interhemispheric transcallosal approach: case report.
Ectopic recurrence of a craniopharyngioma is a rare postoperative complication. We present a case of a craniopharyngioma that ectopically recurred along the tract of a previous surgical route. ⋯ To our knowledge, only eight previous case reports described the ectopic recurrence of a craniopharyngioma. Transplantation of tumor cells along the tract of a previous surgical route in six cases and dissemination in cerebrospinal fluid in two cases are presumed to be the primary mechanisms by which these ectopic recurrences occurred. The results of our literature review led us to conclude that total surgical resection, combined with careful inspection and irrigation of the surgical field, is the optimal treatment for preventing ectopic recurrences. Furthermore, it is recommended that, after primary craniopharyngioma resection, patients undergo long-term clinical and radiological follow-up monitoring for the rare development of an ectopically recurring tumor.
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⋯ Thoracic elevation or an occipital recess to prevent flexion of the head and neck when restrained supine on an otherwise flat backboard may allow for better neutral alignment and immobilization of the cervical spine in children younger than 8 years because of the relatively large head in these younger children and is recommended. Closed reduction and halo immobilization for injuries of the C2 synchondrosis between the body and odontoid is recommended in children younger than 7 years. Consideration of primary operative therapy is recommended for isolated ligamentous injuries of the cervical spine with associated deformity.