Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · May 2014
Review Case ReportsSpontaneous regression of sequestrated lumbar disc herniations: Literature review.
Lumbar disc herniations (LDH) may regress with conservative management; however, this phenomenon is poorly understood for the sequestrated subtype of LDH. We present one of the first comprehensive literature reviews specifically addressing the spontaneous regression of sequestrated intervertebral discs. We reviewed all publications with lumbar disc herniations, sequestrated subtype. ⋯ Sequestrations may have the highest likelihood to radiographically regress in the shortest time frame in comparison to the remaining subtypes of LDH. The most likely mechanism for regression is an inflammatory response elicited against the free fragment. Patients with disc sequestrations may be managed conservatively, in the absence of intractable pain, inability to walk, weakness or symptoms suggestive of cauda equina syndrome.
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Clin Neurol Neurosurg · May 2014
Comparative StudyComparison of morphologic consequences of open and endoscopic carpal tunnel release.
The objective of this study is to evaluate the carpal canal morphologic consequences following endoscopic carpal tunnel release compared with open approach. ⋯ Endoscopic approach causes an increment in carpal canal volume comparable to open technique and provides equivalent anatomic outcomes and will produce at least equivalent long-term clinical relief.
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Clin Neurol Neurosurg · May 2014
Multicenter Study Observational StudyInfluence of antiplatelet therapy on postoperative recurrence of chronic subdural hematoma: a multicenter retrospective study in 719 patients.
The present study tested the hypothesis of whether antiplatelet agents (APA) induce chronic subdural hematoma (CSDH) recurrence via a platelet aggregation inhibitory effect. ⋯ Antiplatelet therapy significantly influences the recurrence of CSDH.
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Clin Neurol Neurosurg · May 2014
Comparative StudyComparison of CT and MRI findings for cervical spine clearance in obtunded patients without high impact trauma.
Cervical spinal injuries occur in 2.0-6.6% of patients after blunt trauma and can have devastating neurological sequelae if left unrecognized. Although there is high quality evidence addressing cervical clearance in asymptomatic and symptomatic awake patients, cervical spine clearance in patients with altered level of alertness (i.e., obtunded patients with Glasgow coma scale (GCS) of 14 or less) following blunt trauma has been a matter of great controversy. Furthermore, there are no data on cervical spine clearance in obtunded patients without high impact trauma and these patients are often treated based on evidence from similar patients with high impact trauma. This retrospective study was conducted on this specific subgroup of patients who were admitted to a neurointensive care unit (NICU) with primary diagnoses of intracranial hemorrhage with history of minor trauma; the objective being to evaluate and compare cervical spinal computed tomography (CT) and magnetic resonance imaging (MRI) findings in this particular group of patients. ⋯ CT is highly sensitive in detecting unstable injuries in obtunded patients with GCS of 14 or less in the absence of high impact trauma. In the absence of high impact trauma, neurosurgeons should be comfortable to discontinue the cervical collar after a negative, high-quality CT in this patient population. In the presence of focal neurological deficits unexplained by associated intracranial injury, an MRI may help diagnose intrinsic spinal cord injuries which necessarily may not be unstable in the presence of a negative CT and does not precludes clearance of cervical spine.
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Clin Neurol Neurosurg · May 2014
Surgical outcomes using wide suboccipital decompression for adult Chiari I malformation with and without syringomyelia.
Posterior fossa decompression with or without duraplasty is the most common surgical technique employed to treat Chiari-1 malformation (CM). There is considerable debate as to whether large versus small craniectomy leads to better outcomes. The aim of this study was to report our technique and outcomes using a wide suboccipital craniectomy with arachnoid sparing duraplasty. ⋯ Surgical technique of wide bony decompression of posterior fossa with arachnoid sparing pericranial duraplasty demonstrates favorable outcomes with an acceptable complication rate for patients with symptomatic CM. Prior CM decompression and non-autologous dural graft were associated with poor outcome. Further study is needed to determine the optimal extent of bony decompression.