Clinical neurology and neurosurgery
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Whether or not a patient could benefit from a computed tomography (CT) scan and/or the evaluation by a neurosurgeon requires judgment by a clinician of the risk of clinical deterioration. To assess this clinical process we aimed to determine how many of the consultations to the Neurosurgical department (NSG) of UC Davis are appropriately indicated for neurosurgical input or management. Secondly, we investigated how CT is used in the University of California Davis Medical Center (UCDMC) in NSG consults of head injured patients compared to a validated and highly sensitive decision making tool, the Canadian CT Head Rule (CCHR). ⋯ NSG receives 3-4 requests for consultations per day from the other services of UCDMC, of which one is of questionable validity and one of the three CT scans for head injury is not necessary. These results suggest the use of the CCHR in UCDMC would improve patient care and could result in large health-care savings, while there would also be less radiation exposure.
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Clin Neurol Neurosurg · Oct 2010
Case ReportsThrombolytic therapy in a patient with acute ischemic stroke caused by aortic dissection.
The current medical literature indicates a poor outcome in patients with ischemic stroke in the presence of aortic dissection, especially in those who underwent thrombolytic therapy. We report a favorable outcome in a patient with acute stroke who received rt-PA and was later found to have Stanford type A aortic dissection.
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Clin Neurol Neurosurg · Oct 2010
The combination of neuronavigation with transcranial magnetic stimulation for treatment of opercular gliomas of the dominant brain hemisphere.
The objective of this study is to investigate the application of transcranial magnetic stimulation combined with neuronavigation for preoperative mapping of the language area in neurosurgical interventions on the opercular area of the dominant hemisphere. ⋯ This method is useful for preoperative localization of the speech area, as well as preoperative planning of the operative approach and intra-operative planning of the direction of brain retraction and operative corridor.
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Clin Neurol Neurosurg · Jul 2010
Sternal cancellous bone graft harvest for anterior cervical discectomy and fusion with interbody cage devices.
Retrospective chart review, technical note, cohort study. ⋯ We describe a modified technique of harvesting the sternal graft and also for the first time describe the long-term clinical outcome of using sternal autograft for ACDF. The sternal manubrium provides a viable alternative to AIC grafting. It confers the advantages of autograft fusion without the complications associated with AIC graft harvesting.
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Intraventricular meningiomas account for 0.5-3% of all intracranial meningiomas. The majority occur in the atrium of the lateral ventricle. Surgical experience with intraventricular meningiomas is rare in the literature, and several surgical approaches exist. ⋯ Several approaches are available for the surgical treatment of intraventricular meningiomas. Tumor location, extension, and laterality drive the selection algorithm for these approaches. Preoperative angiography is rarely useful, and surgical cure is the rule.