Acta neurochirurgica
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Acta neurochirurgica · Jan 2010
ReviewUpdate on protein biomarkers in traumatic brain injury with emphasis on clinical use in adults and pediatrics.
This review summarizes protein biomarkers in mild and severe traumatic brain injury in adults and children and presents a strategy for conducting rationally designed clinical studies on biomarkers in head trauma. ⋯ We conclude that only S-100B in severe traumatic brain injury has consistently demonstrated the ability to predict injury and outcome in adults. The number of studies with protein degradation products is insufficient especially in the pediatric care. Cohort studies with well-defined end points and further neuroproteomic search for biomarkers in mild injury should be triggered. After critically reviewing the study designs, we found that large homogenous patient populations, consistent injury, and outcome measures prospectively determined cutoff values, and a combined use of different predictors should be considered in future studies.
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Acta neurochirurgica · Jan 2010
Meningiomas in the elderly, the surgical benefit and a new scoring system.
The purpose of the study was to define and identify prognostic indicators within an elderly population of patients suffering from intracranial meningiomas. The clinical presentation of the patient with meningioma is diverse, manifesting as a different clinical entity in the elderly patient compared to a similar type of tumor in a young patient. ⋯ The present results suggest that common experience-based considerations may be optimized and implemented into a simple scoring system that in turn may allow for outcome prediction and evidence-based decision making
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Acta neurochirurgica · Jan 2010
Case ReportsLong-term control of clival chordoma with initial aggressive surgical resection and gamma knife radiosurgery for recurrence.
Chordomas are locally destructive tumors with high rates of recurrence, and therapeutic strategies remain controversial. This study analyzed long-term outcomes for clival chordomas after initial aggressive surgical resection and gamma knife radiosurgery for recurrence and investigated clinical factors predicting recurrence. ⋯ Long-term control of clival chordomas was achieved. Recurrent tumors were controlled with gamma knife radiosurgery, since lesions were localized and small after initial aggressive resection. The MIB-1 labeling index can provide important information for predicting tumor recurrence.
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Acta neurochirurgica · Jan 2010
Case ReportsIatrogenic tension pneumothorax resulting in pneumocephalus after insertion of a ventriculoperitoneal shunt: an unusual complication.
We report the case of an iatrogenic tension pneumothorax related to the placement of a ventriculoperitoneal shunt, followed by pneumocephalus. The patient was pending cranioplasty and shunt placement after decompressive craniectomy for acute subdural hematoma and posttraumatic hydrocephalus. Facilitating the severe and potential life-threatening complication was a severe obesity of the patient as well as incorrect surgical technique.
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Acta neurochirurgica · Jan 2010
Case ReportsRetroclival arachnoid cyst presenting with haemorrhage: a brief report of a special case.
Retroclival arachnoid cysts are rarely reported. A 40-year-old woman had a sudden onset of occipitocervical pain. ⋯ At operation, by a right lateral suboccipital approach, an old, intracystic haemorrhage was aspirated and the cyst wall removed totally. This report demonstrated the second case of retroclival cyst presenting with symptomatic spontaneous intracystic haemorrhage.