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Anterior interosseous syndrome vs flexor pollicis longus tendon rupture: electrodiagnosis or sonography? 前骨间综合征vs拇长屈肌腱断裂:电诊断还是超声检查?
Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.07.037
Murat Kara MD, Fevziye Ünsal Malas MD, Bayram Kaymak MD, Levent Özçakar MD
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引用次数: 7
Rhabdomyolysis after transnasal repair of anterior basal encephalocele 经鼻修复前基底脑膨出后横纹肌溶解
Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.05.015
Jamie J. Van Gompel MD , Yasin A. Khan BSc , Eric L. Bloomfield MD , John F. Pallanch MD , John L.D. Atkinson MD

Background

Postoperative Rhabdomyolysis (RM) is rare after neurosurgical procedures. Furthermore, it has not been observed after transnasal approaches. The authors report a case of idiopathic RM occurring after transnasal resection of a sincipital encephalocele.

Case Description

A 32-year-old woman underwent a transnasal resection of a sincipital encephalocele after 6 years of intermittent clear nasal drainage. Postoperatively, she experienced severe back pain, peripheral neuropathy, associated with a markedly elevated creatinine kinase, and severe RM. The patient was treated with hydration and forced urine alkalization and treated symptomatically for her pain and neuropathy. She ultimately made a full recovery without complication.

Conclusion

Rhabdomyolysis is a rare but known complication of neurosurgical procedures. We report the first known case report of RM after a transnasal procedure. Furthermore, a review of documented postneurosurgical cases of RM is presented and reveals that the causes and risk factors for this complication after neurosurgery are similar to those in other surgical subspecialties.

背景术后横纹肌溶解(RM)在神经外科手术后是罕见的。此外,经鼻入路后未观察到这种情况。作者报告了一个病例特发性RM发生后,经鼻切除枕部脑膨出。病例描述:一名32岁的女性在接受了6年断断续续的鼻腔引流后接受了经鼻手术切除枕部脑泡。术后,她经历了严重的背部疼痛,周围神经病变,肌酐激酶明显升高,以及严重的RM。患者接受水合和强制尿碱化治疗,对症治疗疼痛和神经病变。她最终完全康复,没有并发症。结论横纹肌溶解是一种少见但已知的神经外科并发症。我们报告了第一例经鼻手术后RM的病例报告。此外,对神经外科后RM病例的文献回顾显示,神经外科后这种并发症的原因和危险因素与其他外科亚专科相似。
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引用次数: 4
Cerebral ischemia due to compression of the brain by ossified and hypertrophied muscle used for encephalomyosynangiosis in childhood moyamoya disease 儿童烟雾病的脑肌瘤合并症中,骨化和肥大的肌肉压迫大脑导致脑缺血
Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2006.10.076
Hajime Touho MD

Background

Encephalomyosynangiosis is one of the indirect method in which ischemic brain surface is covered by temporal muscle for the treatment of moyamoya disease.

Case Descriptions

A 14-year-old girl who had been treated with bilateral STA-MCA anastomosis and EMS in 1999 was admitted on January 5, 2005. She showed transient incomplete palsy on the left side of the face and the ipsilateral upper extremity. On the day of admission, MRIs/MRA and 3-dimensional regional CBF measurement using stable xenon and CT scanning were conducted after performance of plain CT scanning. The MRI and CT studies showed that ossified and hypertrophied temporal muscle used for EMS to the right MCA territory compressed the brain just under the muscle. MRA demonstrated well-developed collaterals to the territories of the bilateral MCAs via the previously performed anastomosis. The CBF studies disclosed a low CBF value just under ossified and hypertrophied muscle used for EMS on the right side. She showed same transient ischemic attacks repetitively after January 5, 2005.

Conclusions

The repetitive attacks with the transient motor palsy on her left side was thought to be caused by direct compression of the brain by the ossified and hypertrophied muscle used for EMS and decrease in CBF just under it, and its removal was thought to be the treatment of choices. However, the patient and her parents refused the surgical procedure, and she is treated conservatively at present.

背景脑肌纤维病是颞肌覆盖缺血脑表面治疗烟雾病的一种间接方法。病例描述:一名14岁女孩于1999年接受双侧STA-MCA吻合及EMS治疗,于2005年1月5日入院。她表现为左侧面部和同侧上肢短暂性不完全性麻痹。入院当天,在CT平扫后进行mri /MRA、稳定氙气及CT三维区域脑血流测量。MRI和CT研究表明,骨化和肥厚的颞肌用于EMS到右MCA区域,挤压了肌肉下方的大脑。MRA显示通过先前进行的吻合,双侧mca区域的侧支发育良好。脑血流研究显示,在右侧用于EMS的骨化和肥厚肌肉下,脑血流值较低。她在2005年1月5日之后反复出现同样的短暂性脑缺血发作。结论反复发作的左侧一过性运动麻痹可能是由于EMS所用的骨化肥厚肌肉直接压迫大脑,导致其下方脑血流减少所致,切除该肌肉是治疗的选择。然而,患者及其父母拒绝手术,目前对其进行保守治疗。
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引用次数: 11
Commentary 评论
Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.02.016
Gary W. Mathern MD
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引用次数: 0
神经系统疾病诊断的解剖学基础,C.D. Alberstone, M.P. Steinmetz, I.M. Najm, E.C. Benzel。Thieme出版社,纽约(2007),504页;$119.95评级:推荐读者:神经病学,神经外科,ISBN: 9780865779761
Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.07.048
James I. Ausman MD, PhD ((Editor))
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引用次数: 0
Commentary 评论
Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.07.005
Jamie S. Ullman MD
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引用次数: 0
Commentary 评论
Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.05.005
Howard Morgan MD, MA, MS, FACS
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引用次数: 0
Intramedullary spinal cysticercosis cured with medical therapy: case report and review of literature 药物治疗髓内脊髓囊虫病1例报告及文献复习
Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.06.011
Sarbjit Singh Chhiber MCh , Bikram Singh MD , Payal Bansal MD , Kamal Kumar Pandita MD , Susheel Razdan DM , Jangbahudar Singh MD

Background

Spinal intramedullary cysticercosis is a very uncommon manifestation of NCC, which is caused by the larvae of Taenia solium.

Case description

We report a case of spinal intramedullary cysticercosis who presented subacutely. Magnetic resonance imaging dorsal spine and CSF ELISA clinched the diagnosis. Eight weeks of medical therapy resulted in complete clinicoradiological cure.

Conclusion

Surgery used to be the mainstay treatment for spinal intramedullary cysticercosis; however, early diagnosis and medical therapy with albendazole and dexamethasone can obviate the need for surgery in many patients.

脊髓髓内囊虫病是一种非常罕见的NCC表现,它是由猪带绦虫幼虫引起的。病例描述:我们报告一例以亚急性表现的脊髓髓内囊虫病。脊背磁共振成像及脑脊液酶联免疫吸附试验确定诊断。经过8周的药物治疗,临床放射学完全治愈。结论手术是治疗脊髓髓内囊虫病的主要方法;然而,早期诊断和药物治疗阿苯达唑和地塞米松可以避免许多患者需要手术。
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引用次数: 33
Alternative option in the treatment of very small ruptured intracranial aneurysms 治疗极小破裂颅内动脉瘤的另一种选择
Pub Date : 2009-12-01 DOI: 10.1016/j.wneu.2009.09.003
Ming-Shiang Yang MD , Ho-Fai Wong MD , Tzu-Hsien Yang MD , Yao-Liang Chen MD , Si-Wa Chan MD , Huey-Jen Lee MD , Yung Wei Tung MD , Chung-Wei Tu MD , Tai-Yi Chen MD

Background

To evaluate the safety and protective effect of relative undersized coil with loose coil core in the clinical dilemma condition—very small (43.0 mm) ruptured intracranial aneurysm.

Methods

We studied 12 patients (4 men, 8 women) who had suffered from acute ruptured small intracranial aneurysms (2-3 mm in size, with SAH presentation). All subjects underwent a single coil embolization procedure. An undersized coil (equivalent to the neck size or 0.5 mm smaller than the aneurysm diameter) was chosen as the embolizer.

Based on the postembolization angiogram, subjects were divided into 2 groups. One was labeled as the initial complete obliteration group (NR) and the other as the incomplete obliteration group (SR). Fisher exact test and the Wilcoxon rank sum test were used to for statistical analysis.

Results

The technical success rate was 100% without any procedure-related complication. The follow-up interval ranged from 6 to 32 months. No episode of rebleeding or coil migration could be defined in the admissive and following period. Loose coil core were seen in all patients. The total recurrent rate was 8.3% (1/12); only one patient suffered from recurrent lesion in SR group.

Conclusion

The preliminary result showed that under-sized coil packing with loose coil core could provide the protective effect and prevent from further rebleeding for very small ruptured aneurysms. It should be considered as an alternative option in the treatment of acute ruptured very small aneurysms when other conventional strategies are not feasible.

背景评价相对小尺寸松芯线圈在临床困境-极小(43.0 mm)颅内动脉瘤破裂情况下的安全性和保护作用。方法我们研究了12例(男4例,女8例)急性破裂的颅内小动脉瘤(2-3 mm大小,伴有SAH表现)。所有受试者均行单线圈栓塞术。选择一个较小的线圈(相当于颈部大小或小于动脉瘤直径0.5毫米)作为栓塞剂。根据栓塞后血管造影,将受试者分为两组。一组标记为初始完全闭塞组(NR),另一组标记为不完全闭塞组(SR)。采用Fisher精确检验和Wilcoxon秩和检验进行统计分析。结果手术成功率100%,无手术并发症发生。随访时间为6 ~ 32个月。在入院和随访期间没有再出血或线圈移动的发生。所有患者均见线圈芯松动。总复发率为8.3% (1/12);SR组仅有1例复发。结论初步结果表明,对于极小的破裂动脉瘤,采用小尺寸线圈填料和松散线圈芯可以起到保护作用,防止再出血。当其他常规治疗方法不可行时,应考虑将其作为治疗急性破裂的极小动脉瘤的另一种选择。
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引用次数: 14
Extracranial-intracranial bypass surgery at high magnification using a new high-resolution operating microscope: technical note 使用新型高分辨率手术显微镜进行高倍率的颅外-颅内搭桥手术:技术说明
Pub Date : 2009-12-01 DOI: 10.1016/j.surneu.2009.01.030
Nobuhisa Matsumura MD, Takashi Shibata MD, Kimiko Umemura MD, Seiya Nagao MD, Yukio Horie MD

Background

We report a precise technique for EC-IC bypass surgery using a stereoscopic high-resolution microscope at magnifications of 40× and 50×.

Methods

A stereoscopic operating microscope (Mitaka MM50 Surgical Microscope; Mitaka Kohoki Co, Tokyo, Japan) was used in STA-MCA anastomosis. This microscope has 2 optical systems, a standard zooming system, a newly developed high-magnification system, and 4 fixed working distances of 200, 250, 300 and 350 mm, with highest magnifications of 50.4× at 200 mm and 40.3× at 250 mm. High resolution is achieved by a new lens design in the optical system, which makes the image of the object very clear at high magnification. The magnification can be changed depending on the circumstances in a given procedure. The STA-MCA anastomoses were performed using this microscope.

Results

Very small vessels were observable, and arterial anastomosis could be performed precisely at high magnification. All anastomoses were patent on postoperative angiograms.

Conclusions

Use of the new microscope allows visualization and manipulation of small vessels at high magnification and high resolution and may be very useful in EC-IC bypass surgery.

我们报道了一种使用40倍和50倍放大的立体高分辨率显微镜进行EC-IC搭桥手术的精确技术。方法立体手术显微镜(Mitaka MM50外科显微镜;使用Mitaka Kohoki Co, Tokyo, Japan)进行STA-MCA吻合。该显微镜有2个光学系统,一个标准的变焦系统,一个新开发的高倍放大系统,200、250、300和350 mm 4个固定工作距离,200 mm和250 mm的最高倍率分别为50.4倍和40.3倍。高分辨率是通过光学系统中的一种新的透镜设计实现的,它使物体的图像在高放大倍率下非常清晰。放大倍数可以根据给定程序的具体情况而改变。在此显微镜下进行STA-MCA吻合。结果观察到细小血管,高倍镜下可精确吻合动脉。所有吻合口术后血管造影均通畅。结论该显微镜能以高倍率和高分辨率显示和操作小血管,在EC-IC搭桥手术中具有重要的应用价值。
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引用次数: 7
期刊
Surgical Neurology
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