Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Clinical Trial
Globus pallidus stimulation in advanced Parkinson's disease.
Deep brain stimulation (DBS) of the globus pallidus internus (GPi) has become an accepted therapeutic modality in selected Parkinson's disease (PD) patients with severe levodopa-induced dyskinesias (LID) and on-off motor fluctuations. In comparison to subthalamic nucleus DBS there is a paucity of data on GPi DBS outcomes. We present our experience with a group of 20 PD patients (9 unilateral, 11 bilateral) who underwent GPi stimulation. ⋯ No major adverse effects were seen. Unilateral and bilateral GPi DBS provides lasting benefit in PD patients with severe LID. Beneficial effects on off-period motor symptoms are greater with bilateral stimulation; however, with maintenance of dopaminergic medication, unilateral procedures can also provide important and sustained benefits.
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Intraosseous cavernous hemangiomas are rare and not often multifocal. De novo development of a skull cavernous hemangioma has not been described previously. We present a 20-year-old man who was operated upon for a skull cavernoma in the right frontal area and developed a new lesion 3 years later in the right occipital region. ⋯ Surgical removal was performed and histology again showed a cavernous hemangioma. The patient seems to be unique and it is important to keep young patients with the diagnosis of cavernous hemangioma under close follow-up. This supports the experience from parenchymatous cavernous hemangiomas that this malformation may become a dynamic disease.
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Case Reports
Contralateral acute subdural hematoma occurring after removal of calcified chronic subdural hematoma.
Supratentorial craniotomy for a nontraumatic lesion complicated by an acute subdural hematoma on the opposite side is rare. A 47-year-old woman presented with progressive headache and dizziness with no significant past history. Neuroimaging studies revealed a very large calcified chronic subdural hematoma over the entire right hemisphere with prominent mass effect. ⋯ Repeat computed tomography scan for signs of left tentorial herniation demonstrated an acute contralateral subdural hematoma with severe shift of midline structures. We propose a prevention strategy for this event, which has not been previously described. We also discuss possible mechanisms involved in this unexpected complication.
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Comment Letter Case Reports
Posterior decompression and fusion: dorsal migration of the spinal cord is the key!
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Clinical Trial
Hollow bone cement filled with impacted cancellous bone as a substitute for bone grafts in cervical spine fusion.
Autogenous iliac crest bone is the gold standard for graft material in cervical spinal fusion, but a high incidence of donor site morbidity has been reported. Therefore, to achieve a better fusion rate and decrease the rate of donor site morbidity, we used a novel method whereby hollow bone cement filled with impacted cancellous bone is used as a substitute for bone graft in cervical interbody fusion. From 2003 to 2004, 21 patients with cervical spinal disorders who were treated using this method were included in this study. ⋯ Hollow bone cement filled with impacted cancellous bone could be an alternative material for cervical spine interbody fusion. Using this method, we found not only satisfactory growth of cancellous bone in the holes of the bone cement, but also low morbidity in the donor site. However, for this method, the long-term stability, potential complications, and the necessity of instrumentation all require further investigation.