Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Aug 2019
The surgical results of endoscopic third ventriculostomy in long-standing overt ventriculomegaly in adults with papilledema.
Longstanding overt vetriculomegaly in adults (LOVA) is a type of chronic hydrocephalus presumed to begin during infancy, which manifests in adults after a long and slow clinical course. Only a quite small number of LOVA case series have been published, controversies regarding optimal management still exist. The authors describe a series of symptomatic LOVA patients with papilledema treated successfully using endoscopic third ventriculostomy (ETV) at a single institution. ⋯ Endoscopic third ventriculostomy provides an effective treatment for LOVA patients with papilledema, which can improve the symptoms of LOVA and relive papilledema. The fundoscopy is of great value in making decisions related to surgical intervention for LOVA patients.
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Clin Neurol Neurosurg · Aug 2019
NRGN, S100B and GFAP levels are significantly increased in patients with structural lesions resulting from mild traumatic brain injuries.
To determine whether serum neurogranin (NRGN), glial fibrillary acidic protein (GFAP), and calcium-binding protein S100 beta (S100B) levels are associated with traumatic intracranial lesions compared to computed tomography (CT) findings of patients with mild traumatic brain injury (mTBI). ⋯ This is the first study to evaluate NRGN in human serum after mTBI. We confirmed that NRGN levels were significantly higher in CT + patients than CT- patients in the mTBI patient population. Future studies of larger populations and different age groups (especially pediatric) can help reduce the number of CT scans as a reliable and noninvasive diagnostic tool for evaluating NRGN protein levels in mTBI patients with a low probability of intracranial lesions.
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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.