Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Oct 2013
Concomitant and adjuvant temozolomide of newly diagnosed glioblastoma in elderly patients.
The effect of concomitant and adjuvant temozolomide in glioblastoma patients above the age of 65 years lacks evidence. However, after combined treatment became standard at our center all patients were considered for combined therapy. We retrospectively analyzed the effect of temozolomide focused on elderly patients. ⋯ Retrospective matched pair analysis gives class 2b evidence for prolonged survival due to concomitant and adjuvant temozolomide in elderly glioblastoma patients. Until prospective data for combined radiochemotherapy in elderly patients will be available concomitant and adjuvant temozolomide therapy should not be withheld.
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Clin Neurol Neurosurg · Oct 2013
Patients benefit from low-pressure settings enabled by gravitational valves in normal pressure hydrocephalus.
The ability of siphon regulatory devices to improve overdrainage control despite low-pressure settings of the valve for the horizontal body position has been described previously. We aim to provide a systematic investigation on the ability of gravitational units as siphon regulatory devices to improve clinical outcome in shunt therapy. ⋯ Adjustable and gravity-assisted valves like the proGAV® improve overdrainage control and enable thus low-pressure settings for the horizontal body position. We observed an improved and more sustainable functional outcome for iNPH patients with an adjustable and gravity-assisted valve compared to iNPH patients without an integrated siphon regulatory device.
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Clin Neurol Neurosurg · Oct 2013
Randomized Controlled TrialEffect of progesterone administration on prognosis of patients with diffuse axonal injury due to severe head trauma.
Severe traumatic brain injury (TBI) has a major role in mortality rate among the other types of trauma. The aim of this clinical study was to assess the effect of progesterone on the improvement of neurologic outcome in patients with acute severe TBI. ⋯ The use of progesterone may significantly improve neurologic outcome of patients suffering severe TBI up to 3 months after injury, especially those with 5≤GCS≤8, providing a potential benefit to the treatment of acute severe TBI patients. Considering this drug had no significant side effects, so progesterone could be used in patients with severe TBI as a neuro-protective drug.
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Brainstem cavernous malformation (CM) poses a challenge to neurosurgeons in terms of operability, postoperative complications and unpredictable outcomes. The present study was conducted to analyze the clinical parameters that might predict the outcomes and to summarize our center experience in treatment of brainstem CM. ⋯ Favorable surgical outcomes can be predicted in brainstem CM patients with early age at presentation, pontine location of the cavernoma, favorable preoperative mRS and those undergoing early surgery. The outcomes at long-term follow-up were associated with location of the CM in the brainstem, size of the CM and the preoperative mRS.