Acta neurochirurgica
-
Acta neurochirurgica · Jun 2012
The impact of timing of cranioplasty in patients with large cranial defects after decompressive hemicraniectomy.
It is unclear how soon after a decompressive hemicraniectomy that cranioplasty be safely performed in a patient in whom the ICP has been normalized. Early surgery has been associated with infection, intracerebral hematoma, and complications due to persistent or recurrent brain edema. Delayed cranioplasty of large cranial defects exposes the patient to different conditions known in the literature as the syndrome of the sinking skin flap. The purpose of this study was to investigate the hypothesis that timing of cranioplasty after decompressive hemicraniectomy influences outcome and complications. ⋯ Our study suggests that many patients with large cranial defects after decompressive craniectomy can safely undergo cranioplasty in an early stage; direct answers to these questions of timing of cranioplasty are best addressed by prospective studies. Nevertheless, the present study provides a basis for decision-making in certain patients and for the design of future investigations.
-
Acta neurochirurgica · Jun 2012
Effects of darbepoetin-α in spinal cord ischemia-reperfusion injury in the rabbit.
Darbepoetin-alpha (DA) is a novel erythropoiesis-stimulating agent developed for treating anemia. In animal models, recombinant human erythropoietin has been reported to be beneficial for neuroprotection. In this study, we determined whether DA would protect the spinal cord against ischemia-reperfusion injury in a rabbit model. ⋯ Although further studies considering different dose regimens and time intervals are required, DA was shown to be at least as effective as methylprednisolone in spinal cord ischemia/reperfusion model.
-
Acta neurochirurgica · May 2012
Clinical TrialDiscovery of a new waveform for intraoperative monitoring of hemifacial spasms.
Surgeons often rely on intraoperative electrophysiological monitoring to determine whether decompression is sufficient during microvascular decompression surgery for hemifacial spasms. A new monitoring method is needed when an abnormal muscle response is occasionally not available or is unreliable. This study was an observational clinical trial exploring a new waveform recorded from the facial muscles while the offending artery wall was electrically stimulated. ⋯ We found a new waveform for intraoperative monitoring of hemifacial spasm. The Z-L response was useful when the abnormal muscle response was absent before decompression or persisted after all vascular compressions were properly treated. Particularly, the Z-L response may help neurosurgeons determine the real culprit when multiple offending vessels exist.
-
Acta neurochirurgica · May 2012
Case ReportsComplications of delayed cranial repair after decompressive craniectomy in children less than 1 year old.
Decompressive craniectomy is an effective treatment option in case of refractory intracranial hypertension after severe head injury. The incidence of complications following cranial repair after decompressive craniectomy for traumatic brain injury is not negligible, particularly in infants and young toddlers. However, only a few dedicated papers can be found in the literature. ⋯ Infants less than 1 year old, undergoing decompressive craniectomy after traumatic brain injury, experience a high rate of complications following subsequent cranial repair. Subdural collections and resorption of the autologous bone flap are to be considered as extremely common complications.
-
Acta neurochirurgica · May 2012
Management of bilateral trigeminal neuralgia with trigeminal radiofrequency rhizotomy: a treatment strategy for the life-long disease.
The objective of this study was to evaluate the effectiveness of percutaneous controlled radiofrequency trigeminal rhizotomy (RF-TR) in patients with bilateral trigeminal neuralgia (BTN). Patients were analyzed after RF-TR in terms of outcome, safety and complications. ⋯ RF-TR is an effective, selective, well-controlled, and effortlessly repeatable procedure for treating BTN, especially in the elderly, in terms of low morbidity and mortality rates and high rate of satisfactory pain relief.