Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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The importance of preserving the deep cerebral venous outflow has been recognized in microvascular decompression for trigeminal neuralgia; however, few reports have described the details of complications arising from the sacrifice of the superior petrosal vein (SPV). During the procedure in a 77-year-old woman, some tributaries of the SPV complex were sacrificed to achieve microvascular decompression for right trigeminal neuralgia. ⋯ Sacrifice of the SPV may lead to serious, potentially life-threatening complications. Neurosurgeons should pay close attention to the management of the SPV to reduce the risk of venous complications.
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Intradiploic cysts in the posterior fossa are rare. We report a post-traumatic intradiploic leptomeningeal cyst in an adult and review the diagnosis and pathogenesis of this lesion. A 28-year-old woman presented with a headache and a hard mass in the occipital region. ⋯ The dural defect was sutured primarily and covered with the autogenous outer table. An intradiploic cyst of the occipital bone can be detected in adults and might be caused by remote head injuries during childhood. Prompt surgical repair of the dural and bony defect in an adult patient has an excellent prognosis.
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Between January 1996 and December 2003, our department treated 16 patients (10 men and 6 women; average age 57.5 years) by performing a laminectomy for thoracic myelopathy caused by ossification of the ligamentum flavum (OLF). We followed up all patients for 36 to 86 months (mean follow-up time, 57.3 months). The mean (+/-standard deviation) Japanese Orthopaedic Association score increased from 5.0+/-1.4 points before the operation to 7.7+/-1.9 points at the last follow-up (p<0.01). ⋯ An intraoperative dural tear was the main complication and none of the patients developed severe neurological complications. We conclude that laminectomy was both effective and safe in the treatment of thoracic OLF, but it must be performed with great care because of frequent dural adhesions to the OLF. The increase in kyphosis after the laminectomy was minimal when most of the facet joints were left intact and when the patient followed a back extensor exercise program post-operatively.
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Seventy-one patients from northern Sweden were diagnosed with chronic subdural haematomas (CSDH) and treated at the Department of Neurosurgery at Umeå University Hospital over 12 months. Fifty-four patients with CSDH had a history of head trauma (trauma group), while 17 patients had no previous head trauma (non-trauma group). In the non-trauma group 71% of patients were treated with anticoagulants or antiplatelet aggregation agents (AAA) compared to 18% in the trauma group. ⋯ The recurrence rate for all patients was 17%. These findings confirm that the use of anticoagulants and AAA is over-represented in patients with non-traumatic CSDH. In our study, recurrence was not associated with previous use of anticoagulants or AAA.