Neurosurgery
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OBJECTIVES AND IMPORTANCE: Cervical spine compromise by fibrous dysplasia is rare; only 20 cases have been reported. Treatment was surgical in six cases, but the management differed among the other cases. In this retrospective case report, we analyze and discuss the surgical treatment of this condition in the context of previous reports. ⋯ The patient was discharged after 7 days. Three years later, she continued to have no pain, and spine stability was preserved. Good results can be achieved in the surgical treatment of dysplastic tissue with the use of instruments for spine reconstruction and synthetic grafting to prevent invasion.
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To propose endoscopic treatment as an effective initial alternative for patients with a trapped fourth ventricle. ⋯ Endoscopic treatment of the trapped fourth ventricle is effective in most cases. In view of the higher-than-expected revision rate with fourth ventricular shunts and an equivalent complication rate, endoscopic treatment is a reasonable initial treatment option for patients with a trapped fourth ventricle.
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The purpose of this study was to evaluate three modified, fiberoptic, oxygen saturation catheters as monitors of jugular venous oxygen saturation (SjvO2). ⋯ Catheter 3, which is now being marketed as the Opticath P540-H catheter, represents a significant improvement in performance and may make SjvO2 monitoring in the intensive care unit more practical.
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OBJECTIVE AND IMPORTANCE: Brain stem and cerebellar edema rarely have been described as the principal manifestation of hypertensive encephalopathy. In addition, secondary hydrocephalus has been described in only a few cases in the literature. We present an unusual case of posterior fossa swelling and hydrocephalus resulting from hypertensive encephalopathy. ⋯ Subsequent neuroradiological studies revealed decreased posterior fossa edema as well as marked improvement in the hydrocephalus. Hypertensive encephalopathy can present principally in the posterior fossa and can give rise to obstructive hydrocephalus. Invasive treatment of the hydrocephalus is not necessarily required in this clinical setting because reduction of the blood pressure may result in rapid improvement of the hydrocephalus.
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Acute pupillary dilation in a head-injured patient is a neurological emergency. Pupil dilation is thought to be the result of uncal herniation causing mechanical compression of the IIIrd cranial nerve and subsequent brain stem compromise. However, not all patients with herniation have fixed and dilated pupils, and not all patients with nonreactive, enlarged pupils have uncal herniation. Therefore, we have tested an alternative hypothesis that a decrease in brain stem blood flow (BBF) is a more frequent cause of mydriasis and brain stem symptomatology after severe head injury. We determined the relation of BBF to outcome and pupillary response in patients with severe head injuries. ⋯ These findings suggest that pupillary dilation is associated with decreased BBF and that ischemia, rather than mechanical compression of the IIIrd cranial nerve, is an important causal factor. More important, pupil dilation may be an indicator of ischemia of the brain stem. If cerebral blood flow and cerebral perfusion pressure can be rapidly restored in the patient with severe head injury who has dilated pupils, the prognosis may be good.