World Neurosurg
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Case Reports
Surgical resolution of trigeminal neuralgia due to intra-axial compression by pontine cavernous angioma.
Trigeminal neuralgia is usually caused by microvascular conflict with the fifth cranial nerve in the pontocerebellar angle. Rarely is it secondary to other extra-axial or intra-axial lesions. Few cases of trigeminal neuralgia due to cavernous angiomas have been reported in the literature. This is the first report of surgical decompression of the intra-axial trigeminal nerve tract from a deep pontine cavernous angioma. ⋯ Trigeminal neuralgia can occur occasionally secondary to the compressive effect of a pontine cavernous angioma. In this patient surgical removal of the cavernous angioma can be considered a successful and relatively safe treatment.
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To present a summary of anesthetic considerations for use of the sitting position in procedures to remove lesions of the occipital and suboccipital regions, with a special reference to the Helsinki experience with more than 300 operations in 1997-2007, and a retrospective study evaluating the incidence of venous air embolism (VAE) and hemodynamic stability in patients operated in the steep sitting position. ⋯ The sitting position is associated with risk for hypotension. The same surgical approach and procedure does not exclude the occurrence of VAE. In this study, the unaltered hemodynamics in patients during VAE indicates relatively small VAE. Possible explanations for this are early recognition of air leakage and good cooperation between the surgical and anesthesia teams.
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To determine if use of antibiotic-impregnated shunt (AIS) systems to reduce cerebrospinal fluid (CSF) shunt infections in adult patients with hydrocephalus has been cost-effective at one institution. ⋯ In a retrospective cohort study of 500 CSF shunt surgeries performed in adult patients with hydrocephalus, this institution's categorical conversion to AIS catheters was associated with a significant reduction in infection-related medical costs within the first year after surgery. Although prospective randomized cost-utility studies are needed to confirm these observations, these results suggest that AIS catheters are cost-effective in the treatment of hydrocephalus in adult patients.
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With a population of more than 70 million, Turkey has a large demand for neurosurgery. Neurosurgery is provided by a socialized health care system partly supported by private institutions. There are more than 1200 neurosurgeons practicing in Turkey, and sophisticated surgical procedures are performed in most large cities. Residency training is provided at universities and training hospitals, and the quality of care is supported by two neurosurgical societies.