Clinical neurology and neurosurgery
-
Clin Neurol Neurosurg · Aug 2015
The bigger, the better? About the size of decompressive hemicraniectomies.
Decompressive hemicraniectomy (DHC) is a treatment option in refractory ICP elevation and malignant infarction. A minimum diameter of 12 cm has been widely accepted as mandatory for effective decompression for ICP control. Complete hemispheric exposure is frequently advocated to further reduce the risk of parenchymal shear stress, hemorrhage and swelling. At the same time, superior efficacy and comparable risk profile of a more extensive decompression have yet to be established. ⋯ Due to the heterogeneity of underlying disease, a conclusion as to effect of craniectomy size on long-term outcome cannot be made based on this study. However, if the obligatory lower threshold of 12 cm for DHC size and decompression to the temporal base are observed, a smaller craniectomy is equally effective in relieving intracranial hypertension. While not inadvertently associated with a more favorable surgical risk profile, it does not increase the risk for early secondary complications such as parenchymal shear stress, hemorrhage and swelling.
-
Clin Neurol Neurosurg · Aug 2015
Clinical study of C3-C4 level surgical cases of cervical spondylosis.
The purpose of this study was to elucidate the pathological characteristics of C3-C4 cervical spondylotic myelopathy (CSM). ⋯ In C3-C4 ACDF patients, not only static factors, but dynamic factors (instability) at the C3-C4 level contributed to the major causes of CSM.