Acta neurochirurgica
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Acta neurochirurgica · Apr 2010
Increasing hematocrit above 28% during early resuscitative phase is not associated with decreased mortality following severe traumatic brain injury.
To prevent iatrogenic damage, transfusions of red blood cells should be avoided. For this, specific and reliable transfusion triggers must be defined. To date, the optimal hematocrit during the initial operating room (OR) phase is still unclear in patients with severe traumatic brain injury (TBI). We hypothesized that hematocrit values exceeding 28%, the local hematocrit target reached by the end of the initial OR phase, resulted in more complications, increased mortality, and impaired recovery compared to patients in whom hematocrit levels did not exceed 28%. ⋯ Based on this retrospective observational analysis, increasing hematocrit above 28% during the initial OR phase following severe TBI was not associated with improved or worsened outcome. This questions the need for aggressive transfusion management. Prospective analysis is required to determine the lowest acceptable hematocrit value during the OR phase which neither increases mortality nor impairs recovery. For this, a larger caseload and early monitoring of cerebral metabolism and oxygenation are indispensable.
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Acta neurochirurgica · Apr 2010
Case ReportsMultiple lytic lesions of the spine: a rare diagnosis of eosinophilic granuloma in an adult: a case report.
Eosinophilic granuloma (EG) is a rare benign osteolytic lesion observed rarely in adults, with only some 18 cases of spinal location reported in the literature. We present an unusual variant of EG in a 23-year-old man with radiological features of multiple spinal lytic lesions which was evocated of metastatic processes. ⋯ The clinical and radiological findings of EG present dilemmas of both diagnosis and treatment. The etiology is unclear and the therapeutic approach is still controversial.
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Acta neurochirurgica · Apr 2010
Minimally invasive approach to far lateral lumbar disc herniation: technique and clinical results.
To describe our minimally invasive technique for the surgical treatment of far lateral lumbar disc herniation (FLLDH) using MetRx tissue dilators system and a surgical microscope; and to report our experience with this method. ⋯ Our results suggest that this minimally invasive technique is safe and efficacious for the management of FLLDH and might be an alternative to open microsurgical approaches.
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Acta neurochirurgica · Apr 2010
Intramedullary low grade astrocytoma and ependymoma. Surgical results and predicting factors for clinical outcome.
The optimal time point for surgery of intramedullary spinal astrocytomas and ependymomas is often debated on, as predicting factors are poorly defined. The current single-institutional study was conducted to retrospectively analyze prognostic factors for postoperative functional outcome in these patients. ⋯ An MCS of less than 3 and a tumor extent of less than 5 levels are the most important factors for a favorable postoperative functional outcome. Therefore, surgery should be initiated before significant clinical symptomatology or substantial tumor growth occurs.
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Acta neurochirurgica · Apr 2010
Early acute hemispheric stroke after carotid endarterectomy. Pathogenesis and management.
A major stroke after carotid endareterectomy (CEA) is an event that should be managed according to a planned strategy. Literature data on this issue are not definitive. We reviewed our series in the attempt to define an algorithm of treatment if this complication occurs. ⋯ A major stroke after CEA is caused, in most of cases, by the acute ICA occlusion with or without intracerebral embolic occlusion. Reopening of the occluded ICA gives good results when intracerebral vessels are patent and when the occluded ICA is satisfactorily reopened. An algorithm of planned reactions in case of perioperative stroke is finally proposed.