Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Dec 2018
Anticoagulant prophylaxis against venous thromboembolism following severe traumatic brain injury: A prospective observational study and systematic review of the literature.
Venous thromboembolism (VTE) is a serious complication following severe traumatic brain injury (TBI), however, anticoagulant prophylaxis remains controversial due to concerns of intracranial hemorrhage (ICH) progression. We examined anticoagulant prophylaxis practice patterns at a major trauma centre and determined risk estimates for VTE and ICH progression classified by timing of anticoagulant initiation. ⋯ VTE is a common complication after severe TBI. Anticoagulant prophylaxis is often started late (≥3d) post-injury. Randomized trials are justifiable and necessary to provide practice guidance with regards to optimal timing of anticoagulant prophylaxis.
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Clin Neurol Neurosurg · Dec 2018
Relationship between the location of the ventricular catheter tip and the ventriculoperitoneal shunt malfunction.
Ventriculoperitoneal (VP) shunt is the most common neurosurgical procedure to treat obstructive and communicating hydrocephalus, but failures are frequent. The most common causes of shunt failure are malpositioning and obstruction of the ventricular catheter by debris or blood clothes. The knowledge of the relationship between ventricular catheter tip position, etiology of hydrocephalus and patient's age with shunt malfunction may be useful to avoid shunt failure. ⋯ Ventricular catheter tip position is one the most important factor for shunt function.
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Clin Neurol Neurosurg · Dec 2018
Intracranial clear cell meningioma: Clinical study with long-term follow-up in 24 patients.
Clear cell meningioma (CCM) is a rare disease, and controversy about treatment and prognosis of CCMs still exists. We aimed to clarify the natural history, radiological features, histological characteristics, management and prognosis of intracranial CCMs. ⋯ CCMs are rare diseases which have a predilection to affect younger patients and a high rate of recurrence and metastasis. Surgery resection is the first treatment choice. For patients underwent STR or with MIB-1 index ≥3%, we hold further radiotherapy is necessary. Close follow-up of the brain and spine for years is crucial to monitor recurrence or metastasis.
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Clin Neurol Neurosurg · Nov 2018
Relationship of preoperative intramedullary MRI signal intensity and dynamic factors with surgical outcomes of laminoplasty for cervical ossification of the posterior longitudinal ligament.
We aimed to analyze the relationship of preoperative signal intensity on magnetic resonance imaging (MRI) and dynamic factor with surgical outcomes of laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL). ⋯ Given its negative correlation with JOA score recovery rate and positive correlation with high-signal changes on preoperative MRI, higher preoperative segmental ROM may be associated with spinal cord damage due to repeated minor trauma, predicting poor surgical outcome of laminoplasty in cervical OPLL.
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Clin Neurol Neurosurg · Nov 2018
Meta AnalysisThe clinical significance of redundant nerve roots of the cauda equina in lumbar spinal stenosis patients: A systematic literature review and meta-analysis.
Decompression surgery for lumbar spinal stenosis (LSS) is the most performed spine surgery procedure in patients older than 65 years. Around 40% of LSS patients scheduled for decompression surgery have evidence of redundant nerve roots (RNR) of the cauda equina on their magnetic resonance images (MRI). Little is known about the clinical significance of RNR in LSS patients. The objective was to assess the effects of RNR on clinical scores and recovery in older adults diagnosed with LSS. ⋯ There is limited quality evidence that RNR + patients are older, have a longer symptom history and present higher degrees of lumbar stenosis as given by the narrow CSA in comparison to RNR- patients. After decompression surgery RNR + patients have worse clinical scores and lower recovery rates. In view of these results RNR can be seen as a negative prognostic factor in LSS patients.