Neurochirurgie
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Purposes of this study are to describe different parenchymal changes seen after radiosurgery of cerebral arteriovenous malformations and the clinical symptoms which can be associated, and risk factors correlated with them. ⋯ Parenchymal changes are various in expression, signification and clinical symptoms associated with them. They must be known and recognized for better prevention and symptomatic treatment as well.
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Review Clinical Trial
[Management of intractable cancer pain: from intrathecal morphine to cell allograft].
The durable effectiveness of intrathecal morphine administration is well established for the management of intractable cancer pain, after failure of systemic opioids, secondary to the persistence of non-reversible undesirable side effects. Many patients are referred to late in the disease course. This conservative method to control pain of malignant origin must not be reserved for last resort treatment for terminal patients. ⋯ Convincing evidence will require controlled studies. The limitations of this innovative cell therapy and especially the lack of human adrenal gland availability point to the need for new sources of cells. Perspectives include xenogenic or engineered cell lines.
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Different types of neurostimulation are proposed essentially in cases of chronic neuropathic pain, non controlled by anticonvulsivants and antidepressants. The aim is usually to activate a failing inhibitory system, involved in the transmission and the modulation of the nociceptive stimulus. The site of stimulation (transcutaneous, spinal cord, thalamic) is choosen according to the severity of pain and especially the degree of lemniscal dysfunction evaluated by clinical and electrophysiological data. ⋯ When dysfunction or lesion extend to the pre-ganglionic portion, it's preferable to propose stereotactic thalamic stimulation or central gyrus stimulation. The analgesic effect concerns permanent burning pain in the context of sensitive deafferentation: after distal nervous lesions, radicular, plexular or spinal lesions or after stroke with ischemic lesions along the nociceptive pathways. These different methods must only be proposed if there is a frequent clinical and technical monitoring.
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Review Case Reports
[Cerebellar hemorrhage complicating a supratentorial craniotomy. A case report and review of the literature].
Postoperative cerebellar hemorrhage after a supratentorial craniotomy represents a rare event. We report a case of a patient with a meningioma of the jugum who developed suddenly after surgery a neurological deterioration due to a cerebellar hemorrhage detected on the CT scan. An occipital craniectomy and an external ventricular drainage were performed in emergency. ⋯ Pre- and postoperative high blood pressure, lowered intracranial pressure and mispositioning of the head during surgery could be at the origin of the hemorrhage. Size of the hemorrhage, time between diagnosis and treatment represent two prognostic factors. All patients, who present a neurological deterioration in postoperative course, must have CT scan including posterior fossa.
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Review Case Reports
[Arachnoid cysts of the middle fossa and associated subdural hematoma. Three case reports and review of the literature].
We report 3 cases of subdural hematoma associated with arachnoid cyst of the middle fossa, and discuss the treatment. ⋯ We propose subdural hematoma drainage without any specific treatment (shunt or fenestration) of the arachnoid cyst, for this category of patient.