Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Nov 2017
Comparative StudyCervical arthroplasty versus anterior cervical fusion for symptomatic adjacent segment disease after anterior cervical fusion surgery: Review of treatment in 41 patients.
The purpose of this study is to compare the efficacy and safety of anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement (CTDR) as revision surgeries for symptomatic adjacent segment degeneration (ASD) in cases with previous ACDF. ⋯ The 2-year clinical results of CTDR for symptomatic ASD are safe and are comparable to the outcomes of ACDF in terms of arm pain relief and functional recovery. The CTDR group showed better NDI improvement, faster C2-7 ROM recovery, less of an increase in ROM in the inferior adjacent segment, and a lower incidence of adjacent segment degeneration than did the ACDF group.
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Clin Neurol Neurosurg · Nov 2017
Significance of satellite sign and spot sign in predicting hematoma expansion in spontaneous intracerebral hemorrhage.
Hematoma expansion is related to poor outcome in spontaneous intracerebral hemorrhage (ICH). Recently, a non-enhanced computed tomography (CT) based finding, termed the 'satellite sign', was reported to be a novel predictor for poor outcome in spontaneous ICH. However, it is still unclear whether the presence of the satellite sign is related to hematoma expansion. ⋯ This study included 153 patients. Satellite sign was detected in 58 (37.91%) patients and spot sign was detected in 38 (24.84%) patients. Among 37 patients with hematoma expansion, 22 (59.46%) had satellite sign and 23 (62.16%) had spot sign. The sensitivity and specificity of satellite sign for prediction of hematoma expansion were 59.46% and 68.97%, respectively. The sensitivity and specificity of spot sign were 62.16% and 87.07%, respectively. The area under the curve (AUC) of satellite sign was 0.642 and the AUC of spot sign was 0.746. (P=0.157) CONCLUSION: Our results suggest that the satellite sign is an independent predictor for hematoma expansion in spontaneous ICH. Although spot sign has the higher predictive accuracy, satellite sign is still an acceptable predictor for hematoma expansion when CTA is unavailable.
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Clin Neurol Neurosurg · Nov 2017
Comparative StudyStereotactic radio surgery and radio frequency rhizotomy for trigeminal neuralgia in multiple sclerosis: A single institution experience.
For patients with medically unresponsive trigeminal neuralgia (TN), surgical options include micro vascular decompression (MVD), radiofrequency rhizotomy (RF), and stereotactic radio surgery (SRS). Multiple sclerosis (MS) is a demyelinating condition that can be associated with TN, but is not amenable to treatment with MVD. We sought to identify the outcome differences of patients with TN in MS undergoing SRS or RFR in an attempt to identify factors that may influence outcomes. We also evaluated cost outcomes, both initially and over time, based on the index procedure. We performed a retrospective review of our experience with 17 cases. ⋯ TN in the setting of MS is highly difficult to treat medically with SRS and RFR being offered as options for these patients. Both can provide good initial pain relief. For patients who have RFR as their initial procedure, a larger number of procedures are required for relief compared to patients who initially underwent SRS. While there is a significant difference in the cost of the initial procedure, over time, with the cost of required subsequent interventions, there is no significant difference in total costs between the two groups.
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Clin Neurol Neurosurg · Nov 2017
Surgical outcomes after laminoplasty for cervical spondylotic myelopathy: A focus on the dynamic factors and signal intensity changes in the intramedullary spinal cord on MRI.
We aimed to analyze the relationship between the dynamic factors and signal intensity changes in the intramedullary spinal cord on MRI, and surgical outcomes, following double-door laminoplasty for cervical spondylotic myelopathy (CSM). ⋯ Considering the dynamic factors, there was no correlation with C2-7 ROM and surgical outcome, but preoperative segmental ROM and a change in signal intensity of the intramedullary spinal cord on MRI were negatively correlated with surgical outcome. From these results, we suggest that preoperative segmental ROM is possibly associated with spinal cord damage due to repeated minor trauma and affects surgical outcome of laminoplasty.
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Clin Neurol Neurosurg · Oct 2017
Factors associated with an increased risk of perioperative cardiac arrest in emergent and elective craniotomy and spine surgery.
Cardiac arrest following neurosurgery is a devastating complication associated with significant postoperative morbidity and mortality. There are no published studies that have used a large and robust multicenter database to specifically examine demographic and surgical risk factors associated with cardiac arrests following craniotomy and spine surgeries, respectively. ⋯ Identification of patient and surgery specific characteristics from ACS-NSQIP data associated with cardiac arrest following craniotomy and spine surgery may lead to initiatives to reduce morbidity and mortality in the neurosurgical patient population.