British journal of neurosurgery
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Migration of a ventriculoperitoneal shunt catheter is a rare but well-recognised complication in hydrocephalus treatment. Perforation into different organs or through natural or artificial orifices has been described. In this case, the shunt catheter has extruded through a Mitrofanoff appendicovesicostomy.
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Craniotomy is considered less painful than other surgical procedures and supratentorial surgeries are thought to be the least painful among them. We studied the intensity of pain in the postoperative period following a supratentorial craniotomy while using oral paracetamol as the sole analgesic. The effect of temporalis muscle incision on the intensity of pain was also studied. ⋯ Pain following craniotomy is adequately addressed in only about 27% of patients with oral paracetamol. However, the long-term analgesic effect is satisfactory. Persistence of pain of moderate or severe intensity 24 h after a craniotomy could suggest an impending postoperative complication.
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A posterior fossa epidural haematoma (EDH) is uncommon and the diagnosis is difficult because the clinical symptoms are non-specific. Therefore, a computed tomography scan is important for the early diagnosis and management. Thirty-four patients with a posterior fossa EDH were admitted between 2001 and 2008. ⋯ The patients admitted with associated intracranial injuries, such as a contrecoup injury including subdural haemorrhage or traumatic subarachnoid haemorrhage had a poor outcome. The initial GCS score on admission and the presence of associated intracranial injuries were important factors associated with the patient prognosis. A diastatic fracture of the lambdoid suture was associated with complicated venous sinus injuries making surgery more difficult.
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Adjacent segment vertebral compression fracture after lumbosacral instrumented fusion has been reported to be a significant complication. Recently, percutaneous vertebroplasty (PVP) has been widely used for the treatment of non-traumatic osteoporotic vertebral fracture. However, the clinical effect of this minimally invasive treatment option to the post-fusion vertebral fracture has rarely been reported. We analysed characteristics of adjacent vertebral fractures following lumbar fusion and evaluated the clinical outcome of PVP. ⋯ Adjacent vertebral fracture following lumbar fusion may occur as a kind of adjacent segment disease. The increased stress around the fusion segment can cause vertebral fracture even with a relatively higher BMD score. Vertebroplasty for the post-fusion vertebral fracture can be as effective as it is for the usual osteoporotic vertebral fracture.
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To assess surgical results and quality of life after removal of tumours causing ventral compression of the brainstem using the presigmoid or combined presigmoid/retrosigmoid approaches. ⋯ We found favourable surgical results when using the presigmoid approach alone or combined with the retrosigmoid route for large-sized extrinsic tumours causing ventral compression of the brainstem, both regarding complication profile, degree of tumour removal and functional outcome. However, impact of disease and surgery on quality of life appears to be more significant when assessed subjectively by the patients.