British journal of neurosurgery
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The prognostic role of O(6)-methylguanine-DNA methyltransferase (MGMT) promoter methylation in glioblastoma patients treated with carmustine (BCNU) wafer implantation is unclear. Here, we report on a retrospective study of 47 patients with either newly diagnosed (30 patients) or recurrent (17 patients) glioblastoma (WHO grade IV) treated with BCNU (bis-chloroethylnitrosourea) wafers. Thirteen of the newly diagnosed patients received local BCNU and irradiation only (first-line BCNU), while 17 patients additionally received concomitant and adjuvant temozolomide (TMZ) radiochemotherapy (first-line BCNU + TMZ). ⋯ In summary, MGMT promoter methylation showed a non-significant trend toward longer survival in our patient cohort. The combination of TMZ radiochemotherapy with local delivery of BCNU did not provide a significant survival benefit compared to local BCNU alone, but was associated with a higher rate of adverse effects. Owing to the small number of patients investigated, however, these findings would need to be corroborated in larger patient cohorts.
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An accidental durotomy is a recognised and not infrequent complication of lumbar spine surgery, and may lead to postoperative low-pressure headaches, pseudomeningocele and CSF leak. Conventional postoperative management involves a period of flat bed rest. There is no agreement as to the need for and duration of postoperative bed rest. This study aims to determine whether the duration of flat bed rest alters the rate of these complications. ⋯ A longer period of mandatory bed rest does not decrease the rate of complications. Patients should be mobilised as soon as they can. This could potentially reduce the length of hospital stay and the cost of aftercare.
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Dermoid cysts of posterior fossa are uncommon benign lesions. They differ from other lesions found in the infra tentorial compartment by virtue of their associated conditions. Due to their association with dermal sinus tracts, intracranial infection is a potential threat following infection of the cyst. ⋯ In this article we detail our eleven-year-experience with posterior fossa dermoid cysts in fifteen patients. Despite the morbid presentation with severe life-threatening complications, the overall outcome was excellent. Implications of the various associations are discussed.
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Interpositional grafts are often used for extracranial to intracranial artery bypass procedures. However, donors often suffer from size mismatch and donor site morbidity. We sought a novel donor vessel that has not been used for these procedures. ⋯ The AIA is more than long enough to graft the superficial temporal artery at the root of the zygoma to the vessels of the anterior and posterior circulations. This obviates the possibility of ischemic complications following radial artery harvest and graft size mismatch when using other grafts. Indications for the potential use of the AIA may be limited, but they include special situations such as second craniotomy with a previously damaged superficial temporal artery.
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Retroclival haematomas are rare entity and they are mostly caused by trauma. There has been only one case published to have a retroclival haematoma following pituitary apoplexy. We present a patient diagnosed with pituitary apoplexy who was found to have acute subdural retroclival haematoma on the MRI.