World Neurosurg
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Case Reports
Primary intracranial epidermoid carcinoma with diffuse leptomeningeal carcinomatosis: Report of two cases.
Malignant degeneration of epidermoid cyst (EC) with accompanying leptomeningeal carcinomatosis (LC) at presentation is extremely rare. We add two cases to the literature, including the first case of primary brainstem involvement with simultaneous diffuse LC, and discuss clinical and radiological cues to differentiate benign and malignant epidermoid tumors for early diagnosis. ⋯ These cases illustrate that a high index of clinical suspicion is necessary for early diagnosis of disseminated disease in cases of recurrent episodes of aseptic meningitis. In cases of primary benign EC, aggressive resection should be attempted to reduce the risk of malignant degeneration. A separate biopsy specimen from the enhancing portion of the tumor is used to rule out an underlying coexisting malignancy. Multimodal management carries the best prognosis for primary intracranial squamous cell carcinoma with LC.
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Controlled Clinical Trial
Pre-Treatment of Anxiety Prior to Cervical Spine Surgery Improves Clinical Outcomes: A prospective Single Institutional Experience.
Affective disorders such as depression and anxiety have been shown to contribute to inferior outcomes after spine surgery. A high baseline level of anxiety is associated with refractory postoperative pain and patient dissatisfaction with surgery. The aim of this prospective study is to assess whether the pretreatment of anxiety before spine surgery improves patient reported outcomes 1-year after an anterior cervical discectomy and fusion (ACDF) procedure. ⋯ Our study demonstrates that pretreatment of anxiety before cervical spine surgery results in a significant reduction in postoperative neck pain scores and may be a viable management strategy for patients with coexisting affective disorders and cervical spine pathology. Patients awaiting spine surgery should routinely be assessed for anxiety before surgery, and interventions to reduce and treat anxiety should be provided.
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Clinical Trial
Long-term, continuous intra-arterial nimodipine treatment of severe vasospasm following aneurysmal subarachnoid hemorrhage.
Secondary vasospasm and disturbances in cerebrovascular autoregulation are associated with the development of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. An intra-arterial application of nimodipine has been shown to increase the vessel diameter, although this effect is transient. The feasibility of long-term, continuous, intra-arterial nimodipine treatment and its effects on macrovasospasm, autoregulation parameters, and outcome were evaluated in patients with refractory severe macrovasospasm. ⋯ In well-selected patients with prolonged severe macrovasospasm, continuous intra-arterial nimodipine treatment can be applied as a rescue therapy with relative safety for more than 2 weeks to prevent secondary cerebral ischemia. The induced impairment of cerebrovascular autoregulation during treatment seems to have no negative effects.
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Delta-like ligand 4 (DLL4) and Jagged1 (JAG1), 2 vascular Notch ligands, are involved in the process of tumor angiogenesis. The present study investigates their relationship with microvascularization and the prognostic effect in primary glioblastoma. ⋯ DLL4 and JAG1 may have opposing effects on tumor angiogenesis in glioblastoma. The Notch pathway may be a new target for antiangiogenic therapy in glioblastoma.
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Tarlov cyst is an abnormal expansion of the spinal nerve sleeve, and it communicates with the subarachnoid cavity via a perineural fistula. This study presents our experience of a balloon-assisted fistula sealing procedure in treating Tarlov cyst. ⋯ The balloon-assisted fistula sealing procedure is safe and effective for Tarlov cyst, especially for the single cyst. It is a good complement to the cyst wall imbricating procedure.