Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Oct 2018
Successful outcome after outpatient transforaminal decompression for lumbar foraminal and lateral recess stenosis: The positive predictive value of diagnostic epidural steroid injection.
To analyze the positive predictive value of diagnostic 1% lidocaine containing transforaminal epidural steroid injections (TESI) for successful outcome after outpatient endoscopic decompression for lumbar foraminal and lateral recess stenosis. ⋯ The expected VAS pain reduction (>50%) from a lidocaine containing transforaminal epidural steroid injection renders it a valuable diagnostic tool in improving clinical outcome after lumbar endoscopic transforaminal decompression.
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Clin Neurol Neurosurg · Oct 2018
Minimizing overdrainage with flow-regulated valves - Initial results of a prospective study on idiopathic normal pressure hydrocephalus.
Overdrainage and frequent reprogramming are common issues with programmable valves after ventriculoperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (iNPH). Flow-regulated valves may address these limitations, but data on their efficacy are sparse. We present our single-center experience with flow-regulated valves focusing on overdrainage and efficiency. ⋯ The use of the Integra® NPH Low Flow Valve leads to a good neurological outcome and has low overdrainage rates without the need for reprogramming. These results are encouraging and justify further investigation of this valve.
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Clin Neurol Neurosurg · Oct 2018
Subacute combined degeneration of the spinal cord following nitrous oxide anesthesia: A systematic review of cases.
Vitamin B12 deficiency can lead to subacute combined degeneration (SCD). Nitrous oxide (N2O) is an anesthetic which oxidizes the cobalt ion of vitamin B12, interfering with its function as a coenzyme. In this study, we conduct a systematic review of reported cases of SCD following nitrous oxide anesthesia. ⋯ In patients with postsurgical myelopathy, surgeons should evaluate B12 status and consider the possibility that nitrous oxide could cause a subclinical B12 deficiency to become overt, particularly in patients with malabsorptive GI comorbidities. Treatment with B12 in this population can result in significant improvement of neurological function.