Neurochirurgie
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Patients with syndromic faciocraniosynostosis due to the mutation of the fibroblast growth factor receptor (FGFR) 2 gene present premature fusion of the coronal sutures and of the cranial base synchondrosis. Cerebrospinal fluid (CSF) circulation disorders and cerebellar tonsil prolapse are frequent findings in faciocraniosynostosis. ⋯ Different pathophysiological theories have been proposed, but none elucidated all the symptoms present in Apert, Crouzon and Pfeiffer syndromes. The first theory that addressed CSF circulation disruption was the constrictive theory (cephalocranial disproportion): cerebellum and brain stem are constricted by the small volume of the posterior fossa. The second theory proposed venous hyperpressure due to jugular foramens stenosis. The most recent theory proposed a pressure differential between CSF in the posterior fossa and in the vertebral canal, due to foramen magnum stenosis.
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Review Case Reports
Tophaceous gout causing thoracic spinal cord compression: Case report and review of the literature.
To improve neurologists' awareness of spine gout by showing a rare case of tophaceous gout in thoracic spine and a summary of vertebral gout in order. ⋯ The spinal gout should be considered when a patient has chronic or acute back pain and/or neurological symptoms, with mass on sides of the vertebras on MRI, especially when the patient has a history of hyperuricemia, the pathology examination can confirm the diagnosis.
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Review Case Reports
Transoral migration of the inferior end of a ventriculoperitoneal shunt: A case report with literature review.
Ventriculoperitoneal (VP) shunt surgery is the most widely used technique for the treatment of hydrocephalus. However, it can incur certain complications. Beside frequent complications (infection, obstruction), migration of the peritoneal catheter is a rare but dangerous complication. ⋯ Progression was favorable. To the best of our knowledge, only 7 cases of VP shunt transoral extrusion were reported, but many risk factors were identified. Bowel perforation is a serious complication of VP shunt surgery, sometimes leading to fatal outcome.
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Hyperactive dysfunction may affect all cranial nerves in the posterior fossa. According to literature review and personal experience, hemifacial spasm was found to be associated not only with the most frequent cranial nerve syndromes, namely: trigeminal neuralgia, vago-glossopharyngeal neuralgia or VIIIth nerve disturbances manifested by vertigo, tinnitus, hearing decrease, but also with rarer syndromes like geniculate neuralgia, masticatory spasm etc. ⋯ Some could be attributed to neurovascular conflicts from elongated arteries invaginated into the brainstem, and cured by microvascular decompression surgery. When confronted with such complex, and therefore misleading, syndrome, it is advised to search for vascular conflicts at the brainstem using high-resolution MRI exploration.
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Review
Microvascular decompression for hemifacial spasm: Outcome on spasm and complications. A review.
Over the last decades microvascular decompression (MVD) has been established as the curative treatment of the primary Hemifacial Spasm (HFS), proven to be linked in almost all cases to a neurovascular compression of the facial nerve. Because the disease is not life-threatening and MVD not totally innocuous, efficacy and safety have to be weighted before decision taken of indicating surgery. The authors have been charged by the French Speaking Society of Neurosurgery to conduct a detailed evaluation of the probability of relief of the spasm that MVD is able to obtain, together with its potential complications. ⋯ Because MVD for HFS is functional surgery, scrupulous consideration of its potential risks, together with the ways to avoid complications are of paramount importance. When MVD is estimated to have failed, it is wise to wait one year before considering to repeat surgery, as number of patients may benefit from delayed effect. This is the more so as important as repeated surgery entails a higher rate of complications.