Acta neurochirurgica
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External ventricular drainage (EVD) is a freehand neurosurgical procedure performed routinely using the anatomical landmarks. ⋯ Freehand placement of EVDs does not have sufficient accuracy and may lead to drainage dysfunctions. This data suggests that a guidance system for EVD's would be required.
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Acta neurochirurgica · Jan 2012
The usefulness of S100B, NSE, GFAP, NF-H, secretagogin and Hsp70 as a predictive biomarker of outcome in children with traumatic brain injury.
Predicting the long-term outcome after traumatic brain injury (TBI) is an important component of treatment strategy. Despite dramatically improved emergency management of TBI and apparent clinical recovery, most patients with TBI still may have long-term central nervous system (CNS) impairment. ⋯ Although further prospective study is warranted, these findings suggest that levels of biomarkers correlate with mortality and may be useful as predictors of outcome in children with TBI.
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Acta neurochirurgica · Jan 2012
Three years of neurosurgical experience in a multinational field hospital in northern Afghanistan.
Since July 2007, neurosurgical services have been continuously available in a multinational Role 3 field hospital in Mazar-e-Sharif (MeS), Afghanistan. In this paper, we analyse a 3-year neurosurgical caseload experience. ⋯ The primary mission of the field hospital is to provide sick, injured or wounded ISAF personnel with medical and surgical care, the outcome of which must correspond to standards prevailing in Germany. Only a very small number of neurosurgical operations performed in MeS met the criteria established by this mission statement and by the modern principles of damage-control wartime surgery. This is completely different from the experience reported by other ISAF nations in eastern and southern Afghanistan.
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Acta neurochirurgica · Jan 2012
Ventral compression in adult patients with Chiari 1 malformation sans basilar invagination: cause and management.
A small subset of patients with adult Chiari I malformation without basilar invagination (BI) and instability show ventral cervicomedullary distortion/compression and have symptoms pertaining to that. The cause of this ventral compression remains speculative. Additionally, it is unclear if these patients would require ventral decompression with posterior fusion or only posterior decompression would suffice. ⋯ VCMC in adult patients with Chiari I malformation in the absence of BI and/or AAD is due to periodontoid tissue (crown) or retroverted dens. Though a long-term study is required, it appears that all patients with Chiari I malformation, irrespective of the VCMC, can be given a chance with posterior decompression alone. Transoral decompression with posterior fusion may be required in a small subset of patients who fail to improve or worsen following posterior decompression only.
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Acta neurochirurgica · Jan 2012
Advantages of intra-capsular micro-enucleation of schwannoma arising from extremities.
Schwannoma is the most common tumor of the peripheral nerves, with surgical enucleation being the established treatment modality. However, some schwannomas cannot be easily enucleated and this sometimes results in iatrogenic nerve injury even with atraumatic procedures. Here we present a retrospective review of the management of schwannoma in the extremities and compare clinical outcomes from the two techniques of extra-capsular and intra-capsular enucleation. ⋯ These results support intra-capsular micro-enucleation as a safe and reliable treatment for every type of schwannoma. To minimize the risk of nerve injury, en bloc resection should not be used because the main purpose of schwannoma surgery is the relief of symptoms, not tumor resection. Thorough pre-operative counseling of patients to inform them of the potential occurrence of neurological deficit is important.