Clinical neurology and neurosurgery
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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
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.
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Clin Neurol Neurosurg · May 2014
Prediction parameters of bone flap resorption following cranioplasty with autologous bone.
The number of patients who need cranioplasty after decompressive craniectomy has increased. In most cases, autologous bone flaps are used for cranioplasty, and there have been reports of the complication of bone flap resorption. Based on these facts, we analysed patients who underwent cranioplasty in our institution to learn about potential risk factors of cranioplasty. ⋯ Patients with delayed reimplantation and a defect size >120cm(2) show a tendency of aseptic bone flap resorption. In these cases, a patient-specific implant (PSI) could be the first choice material for this procedure to reduce the rate of this complication.
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Clin Neurol Neurosurg · May 2014
Patency of the posterior communicating artery after flow diversion treatment of internal carotid artery aneurysms.
Cerebral aneurysm treatment with the Pipeline Embolization Device (PED) often mandates device placement across the ostia of arteries of the Circle of Willis. We determined the patency rates of the posterior communicating artery (Pcomm) after placement across its ostium a PED and studied neurologic outcomes in these patients. ⋯ Approximately one half of Pcomm arteries demonstrated occlusion or decreased flow at follow-up if the ostia are covered with a flow diversion device. Covering the Pcomm ostium in patients with a P1 did not result in any neurologic deficits.
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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.