Clinical neurology and neurosurgery
-
Clin Neurol Neurosurg · Oct 2013
Comparative StudyAccuracy of tunnelated vs. bolt-connected external ventricular drains.
Ventriculostomy is one of the most common neurosurgical procedures and an important tool in the treatment and monitoring of elevated intracranial pressure. Low accuracy has frequently been reported in the literature with risk of drain misplacement over 20% and with a need for reinsertion in up to 40%. As an alternative to the tunnelated EVD technique we often use a bolt-connected EVD. The aim of the present study was to investigate whether the use of bolt-connected EVDs would lead to higher accuracy, fewer passes and reoperations due to poor placement compared to tunnelated EVDs. ⋯ We have showed in this study that by using a bolt-connected EVD and maintaining the freehanded technique we can significantly increase precision and decrease the number of reoperations due to poor placement.
-
Clin Neurol Neurosurg · Oct 2013
Gamma Knife radiosurgery in the management of brainstem metastases.
Metastases to the brainstem portend a poor prognosis and present a challenge in clinical management. Surgical resection is rarely a viable option. ⋯ Stereotactic radiosurgery is an effective treatment for brainstem metastases and should be considered especially for patients with good performance status.
-
Clin Neurol Neurosurg · Oct 2013
Characteristics of neurological manifestations of Behçet's disease: a retrospective monocentric study in Tunisia.
The aim of the present study was to analyze demographic, clinical and genetic features of Behçet's disease patients with neurological involvement through a monocentric study of a homogenous group of hospitalized patients observed in the same department and to compare them with those of other ethnic and geographic groups. ⋯ Clinical and epidemiological features of NBD are various. In our Tunisian cohort of NBD patients the main characteristic features were male predominance, a relatively high prevalence of CVT, a low prevalence of intra-cranial hypertension and a significant lower frequency of HLA-B51 haplotype.
-
Clin Neurol Neurosurg · Oct 2013
Therapeutic and prognostic implications of subarachnoid hemorrhage in patients who suffered cardiopulmonary arrest and underwent cardiopulmonary resuscitation during an emergency room stay.
Aneurysmal subarachnoid hemorrhage (SAH) is a well-known cause of sudden cardio-pulmonary arrest (CPA). Even after successful cardio-pulmonary resuscitation (CPR), the prognosis of patients following an aneurysmal SAH presenting with CPA remains dismal. However, there have been anecdotal reports of good outcomes with appropriate interventions. Pseudo-SAH resulting from marked elevation of intracranial pressure (ICP) after CPR, can mimic SAH in head computed tomographic (CT) scan. Such manifestations hamper resuscitation or delay appropriate neurosurgical management. This study assessed incidence and clinical characteristics of SAH-CPR or pseudo-SAH-CPR patients among non-traumatic CPA-CPR patients, and investigated their therapeutic and prognostic implication. ⋯ The overall survival between true-SAH and pseudo-SAH group was different significantly. Administering definite treatment for a ruptured aneurysm in instances of true SAH could save patients, albeit infrequently. A Prompt CT scan could guarantee recognition of high-density area, blood in the ventricle, and subsequent identification of the ruptured aneurysm, altogether preventing re-bleeding and warranting further systemic resuscitation.
-
Clin Neurol Neurosurg · Oct 2013
Management and outcome of primary spinal ependymomas: a single center experience from Taiwan.
Surgical treatment of spinal ependymomas requires careful consideration of the relative risks of neurological worsening from surgery. Our aim was to determine the risk factors of neurological deterioration after surgery for spinal ependymomas. ⋯ The risk associated with surgical resection of spinal ependymomas should not be overlooked because of the significant incidence of neurological deterioration. The male gender and long-standing symptom (≥24 months) are risk factors of postoperative neurological worsening. Early diagnosis and surgery are therefore critical for successful treatment of spinal ependymomas.