Acta neurochirurgica
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Acta neurochirurgica · Dec 2010
Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia.
The study aims to assess the efficacy and safety of surgical treatment of trigeminal neuralgia (TN) in our department and to identify prognostic factors. ⋯ Regarding prognosis and outcome, we find that it is very important to classify TN in subgroups (types 1 and 2). Dealing with medically treatment-resistant type 1 TN, MVD and RIZ are reasonably safe and effective interventions. The surgical results dealing with type 2 TN are still very poor. All patients with medically treatment-resistant TN should be offered referral to a neurosurgical unit with experience in treating this painful disease. We recommend using a vector-based pain diagram when evaluating the outcome of multiple interventions.
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Acta neurochirurgica · Dec 2010
Comparative StudyPostoperative MRI examinations in patients treated by deep brain stimulation using a non-standard protocol.
MRI in patients bearing deep brain stimulation (DBS) electrodes may induce cerebral lesions due to electrode heating. To avoid neurological deficits related to MRI, post-operative MRI protocol was installed in our institution. However, our protocol comprised a higher specific absorption rate (SAR) and different positioning of lead excess than the later released electrode manufacturer's guidelines. The objective was to evaluate the safety using this protocol. ⋯ No complications were observed using this MRI protocol in DBS patients. Our results suggest that, within this setting, higher SAR values may be feasible for DBS patients than in the manufacturer's guidelines.
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Acta neurochirurgica · Dec 2010
The effect of lung-protective permissive hypercapnia in intracerebral pressure in patients with subarachnoid haemorrhage and ARDS. A retrospective study.
Lung protective ventilation has a beneficial effect in treating patients with acute respiratory distress syndrome (ARDS). An effect of this ventilation modality is hypercapnia, which leads to increased cerebral blood flow. Since increased cerebral blood flow can induce brain oedema the question arises whether lung protective ventilation can be applied in patients with subarachnoid haemorrhage. ⋯ Patients with higher Hunt and Hess grades of subarachnoid haemorrhage who are predominantly intubated and ventilated and most of them suffer from ARDS can receive lung protective ventilation. In our small patient collective, the occurring hypercapnia did not influence (increase) the intracerebral pressure.
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Acta neurochirurgica · Nov 2010
Multicenter StudyThe brain monitoring with Information Technology (BrainIT) collaborative network: EC feasibility study results and future direction.
The BrainIT group works collaboratively on developing standards for collection and analyses of data from brain-injured patients and to facilitate a more efficient infrastructure for assessing new health care technology with the primary objective of improving patient care. European Community (EC) funding supported meetings over a year to discuss and define a core dataset to be collected from patients with traumatic brain injury using IT-based methods. We now present the results of a subsequent EC-funded study with the aim of testing the feasibility of collecting this core dataset across a number of European sites and discuss the future direction of this research network. ⋯ The BrainIT core dataset is a rich dataset for hypothesis generation and post hoc analyses, provided that studies avoid known limitations in the dataset. Limitations in the current IT-based data collection tools have been identified and have been addressed. In order for multi-centre data collection projects to be viable, the resource intensive validation procedures will require a more automated process and this may include direct electronic access to hospital-based clinical data sources for both validation purposes and for minimising the duplication of data entry. This type of infrastructure may foster and facilitate the remote monitoring of patient management and protocol adherence in future trials of patient management and monitoring.