Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jan 2015
Comparative StudyExternal ventricular drain placement in the intensive care unit versus operating room: evaluation of complications and accuracy.
External ventricular drain (EVD) placement is a common neurosurgical procedure performed in both the intensive care unit (ICU) and operating room (OR). The optimal setting for EVD placement in regard to safety and accuracy of placement is poorly defined. ⋯ Patients who underwent ventriculostomy placement in the ICU differed in important ways (i.e. indication for placement and the administration of pre-procedure prophylactic antibiotics) from patients treated in the OR. However, the available data suggests that complications of hemorrhage, infection, and non-functional drains may be mitigated by ventriculostomy placement in the OR.
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Clin Neurol Neurosurg · Jan 2015
Decompressive hemicraniectomy with or without clot evacuation for large spontaneous supratentorial intracerebral hemorrhages.
The management of patients with supra-tentorial intracerebral hemorrhage (ICH) remains controversial. Here we critically evaluate the safety, feasibility, and outcomes following decompressive hemicraniectomy (HC) with or without clot evacuation in the management of patients with large ICHs. ⋯ Early HC with or without clot evacuation is feasible and safe for managing spontaneous ICH. Our experience in this uncontrolled retrospective series, the largest such series in the modern era, suggests that it may be of particular benefit in patients with large non-dominant hemisphere ICH who are not moribund at presentation. Our findings suggest that a prospective randomized trial of HC vs. craniotomy for ICH be conducted.
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Clin Neurol Neurosurg · Jan 2015
Review Case ReportsA review of the combined medical and surgical management in patients with herpes simplex encephalitis.
Herpes simplex encephalitis (HSE) is a devastating and severe viral infection of the human central nervous system. This viral encephalitis is well known to cause severe cerebral edema and hemorrhagic necrosis with resultant increases in intracranial pressure (ICP). While medical management has been standardized in the treatment of this disease, the role of aggressive combined medical and surgical management including decompressive craniectomy and/or temporal lobectomy has not been fully evaluated. In addition, while barbiturate coma has been studied for treatment of status epilepticus associated with infectious encephalitis, its use for treatment of encephalitis associated intractable intracranial hypertension has not been fully reported. ⋯ We provide evidence that aggressive combined medical and surgical therapy is warranted even in cases of severe HSE with transtentorial herniation, as there is evidence for the potential of good recovery. A detailed literature review of the medical and surgical management strategies in this disease is presented.
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Clin Neurol Neurosurg · Jan 2015
Diagnosis and management of dural arteriovenous fistulas: a 10 years single-center experience.
Dural arteriovenous fistulas (DAVFs) are a challenging condition in vascular neurosurgery. Disease natural history and its management is still debated. In the present paper we report our center series on DAVFs over a period of 10 years. Our data were compared with relevant literature. ⋯ DVAFs distribution, clinical presentation and hemorrhagic risk are discussed. Cavernous sinus DAVFs are the most common site in our series. Other locations in order of frequency are transverse-sigmoid sinus, tentorial, anterior cranial fossa, spinal and foramen magnum. The majority of patients presented with non-aggressive symptoms. 18% presented with intracranial hemorrhage: all the hemorrhages occurred in high-grade DAVFs. For most patients, endovascular treatment, transarterial or transvenous, was the first option. Surgery was performed for the anterior cranial fossa DAVFs and other complex lesions draining mostly transverse-sigmoid sinus and tentorium. In 7% of cases a combination of endovascular+surgical treatment was used. Our series has been carefully analyzed in comparison 'side by side' with most relevant literature on DVAFs, focusing particularly on management strategies, therapeutic options and risks related to treatment.
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Clin Neurol Neurosurg · Jan 2015
Skull base atypical meningioma: long term surgical outcome and prognostic factors.
The aim of this study was to examine the clinical outcomes of treating atypical meningioma at the skull base region following surgical resection and adjuvant radiotherapy, and to analyze the association between clinical characteristics and progression free survival. ⋯ For patients with skull base atypical meningiomas, GTR is desirable for longer PFS, unless radical excision is expected to lead to severe complications. Adjuvant radiation therapy is advisable to reduce tumor recurrence regardless of the extent of surgical resection. Age of disease onset and the MIB-1 index of the tumor were both independent prognostic factors of clinical outcome.