Acta neurochirurgica
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Acta neurochirurgica · Mar 2015
Updated periodic evaluation of standardized neurointensive care shows that it is possible to maintain a high level of favorable outcome even with increasing mean age.
Periodic evaluation of neurointensive care (NIC) is important. There is a risk that quality of daily care declines and there may also be unrecognized changes in patient characteristics and management. The aim of this work was to investigate the characteristics and outcome for traumatic brain injury (TBI) patients in the period 2008-2009 in comparison with 1996-1997 and to some extent also with earlier periods. ⋯ A large-proportion favorable outcome was maintained despite that patients >60 years with poorer prognosis doubled, indicating that the quality of NIC has increased or at least is unchanged. More surgery may have contributed to maintaining the large proportion of favorable outcome. For future improvements, more knowledge about TBI management in the elderly is required.
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First introduced by Pimenta et al. in 2001, the extreme lateral interbody fusion (XLIF®) approach is a safe and effective alternative to anterior or posterior approaches to lumbar fusion, avoiding the large anterior vessels and posterior structures including the paraspinous muscles, facet joint complexes and tension bands. ⋯ • Correct lateral positioning with an orthogonal orientation of the corresponding lumbar vertebral body is of key importance. • Subsequent table repositioning for every level is advised in multilevel cases. • Posterior structures including the paraspinous muscles, facet joint complexes and tension bands are mostly preserved. • Meticulous preoperative planning of the psoas docking point, considering all level-specific vascular and neuronal elements, is of paramount importance. • In general, concavity is recommended for the selection of the approach side. • A careful endplate and contralateral preparation and release are mandatory in order to allow bony fusion and maximum indirect foraminal decompression. • Using a perioperative dexamethasone bolus seems to be effective at the L4/5 level to reduce postoperative plexopathy. • Overdistraction should be avoided in order to prevent cage subsidence. • A major disadvantage is the relatively high, but mostly only transient, incidence of psoas weakness as well as hip-groin-thigh pain, dysaesthesia and/or numbness. • Major advantages include indirect neurological decompression, minimal blood loss, shorter operation times, decreased overall infection rates and more surface for bony fusion.
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Acta neurochirurgica · Mar 2015
Burr hole is not burr hole: technical considerations to the evacuation of chronic subdural hematomas.
The organization of a multicenter survey about chronic subdural hematomas has triggered the discussion on different surgical techniques of burr hole evacuation. Such a standard operation gives neurosurgeons plenty of scope for creating their own way. ⋯ We present a thorough summary that could serve as a common standard and as a basis for comparison of future trials.
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Acta neurochirurgica · Feb 2015
Case ReportsCerebellar retraction and hearing loss after microvascular decompression for hemifacial spasm.
This retrospective study evaluated the length of cerebellar retraction and the changes of intraoperative brainstem auditory evoked potential (BAEP) during microvascular decompression (MVD), and assessed the predictive value of the hearing loss as a prognostic indicator for the treatment outcome of hemifacial spasm (HFS). ⋯ Preoperative measurement of the cerebellar retraction distance can be a valuable clue to predict and prevent postoperative hearing loss in MVD for HFS.