Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jul 2019
The LACE+ index fails to predict 30-90 day readmission for supratentorial craniotomy patients: A retrospective series of 238 surgical procedures.
The LACE + index (Length of stay, Acuity of admission, Charlson Comorbidity Index (CCI) score, and Emergency department visits in the past 6 months) is a tool utilized to predict 30-90 day readmission and other secondary outcomes. We sought to examine the effectiveness of this predictive tool in patients undergoing brain tumor surgery. ⋯ The results of this study show that the LACE + index is ill-equipped to predict 30-90 day readmissions in the brain tumor population and further analysis of significant covariates or other prediction tools should be undertaken.
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Clin Neurol Neurosurg · Jul 2019
Meta AnalysisComparative safety and efficacy of percutaneous approaches for the treatment of trigeminal neuralgia: A systematic review and meta-analysis.
Percutaneous treatments for trigeminal neuralgia (TN) include glycerol rhizotomy (GR), radiofrequency thermocoagulation (RF), and balloon compression (BC), which aim to provide pain relief by targeted injury to the trigeminal nerve pain fibers. All three techniques are well established and can provide immediate pain relief; however each of them can be associated with a range of complications. Our objective was to compare the safety and efficacy of GR, RF and BC in patients with TN. ⋯ The comparisons of BC vs RF comprised 3,183 patients and did not show significant differences between the two groups. RF is associated with statistically significant higher odds for immediate pain relief and anesthesia and lower risk for post-operative herpes eruption as compared to GR. Patients in the BC group had a statistically significant higher risk to develop post-operative mastication weakness and diplopia when compared to GR.
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Clin Neurol Neurosurg · Jul 2019
Cefazolin versus vancomycin for neurosurgical operative prophylaxis - A single institution retrospective cohort study.
Cefazolin and vancomycin are common choices for neurosurgical antimicrobial prophylaxis. Cefazolin is typically first-line due to its lower toxicity profile and specificity for gram-positives such as skin commensals, while vancomycin is often reserved for patients with cephalosporin or penicillin allergies. However, one randomized clinical trial demonstrated superiority of vancomycin for cerebrospinal fluid (CSF) shunt insertions at a hospital with a high prevalence of methicillin-resistance Staphylococcus aureus (MRSA). We aimed to evaluate the association of prophylaxis choice and incidence of surgical site infection (SSI) at our own institution. ⋯ There was no significant difference in neurosurgical site infection incidence when vancomycin prophylaxis was substituted for cefazolin. S. aureus was isolated from patients who received cefazolin at a higher rate although this was not statistically significant. At our institution, S. aureus makes up 36% of isolated organisms from inpatient and intensive care units. Institutions should consider their own investigations into local antibiograms, SSI rates, and choice of prophylaxis.
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Clin Neurol Neurosurg · Jul 2019
Analysis of factors influencing ligamentum flavum thickness in lumbar spine - A radiological study of 1070 disc levels in 214 patients.
The pathomechanism and factors influencing hypertrophy of the Ligamentum flavum in the lumbar spine still requires a confident specificity. We aimed to analyse the association between various factors and Ligamentum Flavum Thickness (LFT) and also to investigate the major contributor for Ligamentum Flavum Hypertrophy (LFH) at various levels in the lumbar spine. ⋯ Higher Pfirrmann's grade and decreased anterior disc height can lead to ligamentum flavum hypertrophy at L1-L2, L2-L3,L3-L4,L4-L5 levels.Whereas at L5-S1 level, it is the presence of facet tropism which can cause LFH. Hence, patients with the presence of above mentioned factors at those respective levels have higher preponderance to develop Lumbar canal stenosis.
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Clin Neurol Neurosurg · Jul 2019
Prognostic significance of O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation and isocitrate dehydrogenase-1 (IDH-1) mutation in glioblastoma multiforme patients: A single-center experience in the Middle East region.
To determine the prevalence and prognostic value of MGMT promoter methylation and IDH1 mutation in glioblastoma multiforme (GBM) patients from the Middle East. ⋯ Patients with GBM from the Middle East have adequate survival outcomes when given the optimal treatment. In our patient population, MGMT promoter methylation did not seem to correlate with outcomes, but patients with IDH1 mutation had numerically higher survival outcomes.