Acta neurochirurgica
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Acta neurochirurgica · Nov 2008
Transsphenoidal approaches to the pituitary: a progression in experience in a single centre.
Evolving of a single centre by means of different transsphenoidal approaches during the survey of methodological advances in pituitary surgery is presented. ⋯ Technologic advancements in endoscopy and gaining experience in pituitary surgery drives neurosurgeons toward less invasive approaches.
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Acta neurochirurgica · Nov 2008
Case ReportsIntractable hiccups as a presenting symptom of Chiari I malformation.
Hiccups as the only presenting symptom in neurosurgical practice is uncommon. ⋯ Chiari malformation should be considered in patients with intractable hiccups, who are otherwise asymptomatic for any neurological problems.
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Failed-back surgery syndrome remains a challenge for spinal surgeons. It can be related to several causes, including poor surgical indication, misdiagnosis, surgical technique failure, spondilodiscitis and fibrosis. Fibrosis has been associated with a poorer outcome in lumbar disc surgery, although its role in the generation of symptoms is not yet clear. In this study, the authors have analyzed any possible correlation between the clinical outcome and the degree of fibrosis. ⋯ The authors found no correlation between excessive fibrosis with lumbar and leg pain, disability or straight leg resistance. The role of fibrosis in the generation of symptoms in patients who have had lumbar disc surgery should be reevaluated.
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Acta neurochirurgica · Oct 2008
Randomized Controlled Trial Multicenter StudyBrain metabolic and hemodynamic effects of cyclosporin A after human severe traumatic brain injury: a microdialysis study.
Mitochondrial dysfunction is a major limiting factor in neuronal recovery following traumatic brain injury. Cyclosporin A (CsA) has been recently proposed for use in the early phase after severe head injury, for its ability to preserve mitochondrial bioenergetic state, potentially exerting a neuroprotective effect. The aim of this study was, therefore, to evaluate the effect of CsA on brain energy metabolism, as measured by cerebral microdialysis, and on cerebral hemodynamics, in a group of severely head injured patients. ⋯ The administration of CsA in the early phase after head injury resulted in significantly higher extracellular fluid glucose and pyruvate, which may be evidence of a beneficial effect. The early administration of CsA was also associated with a significant increase in MAP and CPP and such a potentially beneficial hemodynamic effect might contribute to a neuroprotective effect.
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Acta neurochirurgica · Oct 2008
Antibiotic impregnated external ventricular drainage and third ventriculostomy in the management of hydrocephalus associated with posterior cranial fossa tumours.
The effectiveness of antibiotic pre-treated ventricular catheters in reducing the risk of CSF infections (determined on CSF cultures) resulting from the use of per-operative external ventricular drainages (EVD) and the success rate of post-operative endoscopic third ventriculostomy (ETV) in the management of persistent hydrocephalus after posterior cranial fossa tumour removal are assessed. ⋯ Antibiotic pre-treated catheters in our experience considerably limited EVD-related bacterial growth in the CSF. Preoperative hydrocephalus resolved in 60% of the cases after tumour removal, thus confirming recent data from the literature against the routine use of preoperative ETV. In our experience postoperative ETV had a high success rate; poor results were obtained in children with tumour seeding and/or the evidence of positive CSF cultures.