Surg Neurol
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Syringomyelia is a common intramedullary lesion associated with spinal arachnoiditis and obstruction of the foramen magnum such as in Chiari's malformation. Disturbance of cerebrospinal fluid flow around the spinal cord has an important role in the development of syringomyelia due to spinal arachnoiditis; however, the exact mechanisms have not been clarified. The purpose of this retrospective study is to understand the clinical features and pathomechanisms of syringomyelia secondary to spinal arachnoiditis and to provide the current choice of surgical treatment in this difficult clinical entity. ⋯ The syrinx originated from the thoracic levels where severe adhesion of the subarachnoid space was present. The mechanisms of syrinx formation may be based on the increased interstitial fluid in the spinal cord. Shunting procedures were effective in some population of the patients. Decompression procedures of the spinal subarachnoid space may be an alternative primary surgical treatment except for patients with longitudinally extensive arachnoiditis.
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The surgical management of depressed skull fractures is determined in part by whether a fracture is open or closed. Open fractures are usually elevated surgically, but closed fractures are most often treated nonoperatively, and the only 2 indications commonly described for operative treatment of closed fractures are hematoma evacuation and correction of cosmetic deformity. There is another indication, however, that is occasionally encountered when a depressed skull fracture injures a venous sinus. ⋯ The fracture was surgically elevated to relieve the compression of the SSS and the encephalopathy resolved. The clinical identification, the imaging, and the risks and benefits of operative repair of this condition are reviewed. Increased ICP secondary to venous sinus injury is not commonly described in association with closed depressed skull fractures, but should always be considered in patients with the appropriate clinical findings when a fracture overlies a venous sinus, even in the absence of a hematoma.
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The study aims to elucidate the advance of diagnosis and surgical treatment of brainstem hemangioblastomas (BSHs). ⋯ Two types of BSHs can be identified. Patients with cystic IBS type could obtain excellent outcome after operations. Patients with giant or large solid BSHs remain a challenge to neurosurgeons. A combined strategy of preoperative embolization, mild hypothermia with or without hypotension, microsurgical technique, and intensive perioperative management are mandatory for removal of these kinds of tumors with acceptable morbidity and mortality.
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Randomized Controlled Trial Clinical Trial
Ventriculoperitoneal shunt of continuous flow vs valvular shunt for treatment of hydrocephalus in adults.
Shunting for hydrocephalus is the neurosurgical procedure most frequently associated with long-term complications. We developed an alternative to valvular shunts based on a simple shunt procedure whose functioning depends on a peritoneal catheter with a highly precise cross-sectional internal diameter of 0.51 mm. Preliminary studies have shown that the shunt of continuous flow (SCF) is superior to valvular shunts for the treatment of hydrocephalus in adults. Here, we show the long-term performance of the SCF in adult patients with hydrocephalus secondary to a comprehensive variety of neurological disorders. ⋯ The design of the SCF was calculated according to the mean rates of cerebrospinal fluid production; it takes simultaneous advantage of the intraventricular pressure and the siphon effect and complies with the principle of uninterrupted flow, maintaining a fair equilibrium that prevents under- and overdrainage. The SCF is a simple, inexpensive, and effective treatment for hydrocephalus in adults.
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Comparative Study
Subarachnoid hemorrhage on computed tomography scanning and the development of cerebral vasospasm: the Fisher grade revisited.
The Fisher grade (FG) is widely used to predict cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). We revisited the grading scale to determine its validity in the era of modern management. ⋯ Symptomatic vasospasm occurred in 21% of cases. The FG correlated with symptomatic vasospasm in only half the patients. A new predictive CT grading scale for vasospasm may be necessary.