Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Oct 2015
Treatment of selected syringomyelias with syringo-pleural shunt: the experience with a consecutive 26 cases.
It is well established that syringomyelia can cause neurological symptoms and deficit by accumulation of fluid within syrinx cavities that lead to internal compression within the spinal cord. When other intervention treating the underlying etiology failed to yield any improvement, the next option would be a procedure to divert the fluid from the syrinx cavity, such as syringo-subarachnoid, syringo-peritoneal or syringo-pleural shunting. The indications and long term efficacy of these direct shunting procedures are still questionable and controversial. ⋯ Collapse or remarkable shrinkage of the syrinx by SPS could ameliorate or at least stabilize the symptoms for the patient. We recommend small laminectomy and a less than 3mm myelotomy either at PML or DREZ. The SPS procedure can be an effective and relatively long-lived treatment for the idiopathic syringomyelia and those that failed other options.
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Clin Neurol Neurosurg · Oct 2015
Long-term follow-up study of 35 cases after endovascular treatment for vertebrobasilar dissecting aneurysms.
Vertebrobasilar dissecting aneurysm (VBDA) management is challenging despite the availability of multiple treatment strategies. We reviewed our experiences using endovascular treatment for VBDA patients to assess the efficacy and safety of several VBDA treatment strategies. ⋯ For patients with ruptured VBDAs, the complication rate associated with endovascular treatment is acceptable. CE+PT is better than stent coiling in preventing aneurysmal rerupture, but is associated with a high incidence of ischemic stroke. For unruptured VBDAs, endovascular treatment is associated with good clinical outcome without perioperative complications, including rerupture and ischemic stroke. However, the high postoperative recurrent aneurysm risk suggests the necessity of long-term angiographic follow-up monitoring of VBDA patients who undergo endovascular treatments.
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Clin Neurol Neurosurg · Oct 2015
Aspirin Response Test role in platelet transfusion following intracerebral hemorrhage.
Spontaneous intracerebral hemorrhage (ICH) results in high morbidity and mortality. A target for therapy might be hematoma expansion, which occurs in a significant proportion of patients, and can be exacerbated by antiplatelet medications, such as aspirin. It is not clear whether platelet transfusion neutralizes aspirin. The Aspirin Response Test (ART) is commonly ordered in this patient population, but it is not clear whether the results of this test can help select patients for transfusion of platelets. The aim of our study is to investigate whether a selected group of ICH patients, those with reduced platelet activity ("aspirin responders"), will benefit from platelet transfusion. ⋯ Our data suggest that platelet transfusion following an ICH in "aspirin responders" does not reduce hematoma expansion rates in those patients. A larger prospective study is needed.