Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Comparative Study
Increased risk of lead fracture and migration in dystonia compared with other movement disorders following deep brain stimulation.
Deep brain stimulation (DBS) therapy is a continually expanding field in the functional neurosurgical treatment of movement disorders. However, the occurrence of adverse events related to implanted hardware cannot be overlooked. ⋯ Interestingly, all of these failures occurred in dystonia patients (18.4% of all dystonia patients and 9.2% of all electrodes). We postulate on mechanisms that may explain why these complications predominate in this group of patients.
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A 24-year-old woman was struck on the head by a hammer. Because of early signs and symptoms of intercranial hypertension, she underwent surgery for elevation of the depressed fragments which was compressing the superior sagittal sinus (SSS). After operation, the intracranial pressure (ICP) once decreased, but it gradually increased again. ⋯ After brain edema had subsided, a follow-up angiogram revealed normal blood flow through the SSS. Elevation of depressed bony fragments is required for a case presenting with early signs and symptoms of intracranial hypertension due to sinus compression. In a case with severe destruction of the SSS, one needs to know that re-occlusion of the dural sinus may occur after surgical recanalisation.
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Subdural hygroma is a frequent delayed complication of head trauma. Most hygromas are clinically 'silent' and a few cases have shown slow deterioration in the chronic stage. We report a case of subdural hygroma showing unique radiological findings and rapid deterioration. ⋯ Simple burr hole irrigation was performed to remove the subdural hygroma and the patient showed an excellent recovery. Careful examination of the radiological findings prevented an unnecessary procedure in this case. A possible mechanism of this phenomenon is discussed.
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Case Reports
Epidural hematoma of the cervical spine after cervical laminectomy in a patient with ventriculo-peritoneal shunt.
Cervical laminectomy is one of the most common procedures performed in the sitting position. However in the presence of intracranial hypotension, a negative intradural pressure develops when the patients are in the sitting position. ⋯ When performing a cervical laminectomy procedure on a shunted patient, an upright position should be avoided during the operation. Intra-operative hypercapnia as well as intra- and post-operative intravenous hydration should be maintained in order to increase intradural pressure, preventing the formation of cervical spinal epidural hematoma after cervical laminectomy.