Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Apr 2017
ReviewBlood transfusion indications in neurosurgical patients: A systematic review.
Neurosurgical procedures can be complicated by significant blood losses that have the potential to decrease tissue perfusion to critical brain tissue. Red blood cell transfusion is used in a variety of capacities both inside, and outside, of the operating room to prevent untoward neurologic damage. ⋯ Recently, a paradigm shift has occurred in neurocritical intensive care units, whereby restrictive transfusion is increasingly favored over liberal transfusion but the ideal strategy remains in clinical equipoise. The authors of this study perform a systematic review of the literature with the objective of capturing the changing landscape of blood transfusion indications in neurosurgical patients.
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Clin Neurol Neurosurg · Apr 2017
Comparative StudyA comparison of local bone graft with PEEK cage versus iliac bone graft used in anterior cervical discectomy and fusion.
Anterior cervical discectomy and fusion (ACDF) is a popular procedure for patients with cervical spondylotic myelopathy, but few studies reported the clinical outcomes of cervical local bone graft with a PEEK cage used in it. This retrospective study was performed to compare the clinical and radiological outcomes of using local bone graft with a PEEK cage versus iliac bone graft in ACDF. ⋯ Based on this study, patients receiving ACDF with local bone graft combined with a PEEK cage had significant shorter operation time, lower perioperative complications rate, and better radiological results comparing with those with an iliac bone graft alone. It seems that the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft for ACDF.
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Clin Neurol Neurosurg · Mar 2017
Review Meta AnalysisCalcitonin gene-related peptide monoclonal antibody for preventive treatment of episodic migraine: A meta analysis.
Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) have shown promise in the preventive treatment of migraine. Therefore, we performed a meta-analysis to evaluate the efficacy and safety of CGRP mAbs for preventive treatment of migraine. Database including Ovid-SP, Cochrane Library, Pubmed and Web of Science (ISI) were systematically searched up to April 2, 2016 for randomized controlled trials(RCTs) which were dealing with the efficacy and safety of CGRP mAbs for preventive treatment of episodic migraine. ⋯ And CGRP mAbs improved the decrease of monthly migraine days from baseline to week 9-12, no matter in single dose subgroup (WMD=1.83, 95%CI=[0.06,3.60], I2=69%,P=0.04) or in multiple doses subgroup (WMD=1.77, 95%CI=[0.40,3.14], I2=61%,P=0.01). And there were no difference in incidence of adverse events between CGRP mAb group and placebo group. In conclusion, CGRP mAbs was a safety and effective preventive treatment for episodic migraine.
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Clin Neurol Neurosurg · Mar 2017
Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration.
The most painful stages of craniotomy are the placement of the pin head holder and the skin incision. The primary aim of the present study is to compare the effects of the scalp block and the local anesthetic infiltration with bupivacaine 0.5% on the hemodynamic response during the pin head holder application and the skin incision in infratentorial craniotomies. The secondary aims are the effects on pain scores and morphine consumption during the postoperative 24h. ⋯ The scalp block may provide better analgesia in infratentorial craniotomies than local anesthetic infiltration.
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Clin Neurol Neurosurg · Mar 2017
Analysis the causes of radiosurgical failure in intracranial meningiomas treated with radiosurgery.
Surgical resection is a primary indication for intracranial meningioma. Radiosurgery is also an excellent treatment modality for postoperative residual tumors, or tumors in high-risk locations, such as the skull base. Despite multimodality treatments, there are some cases in which radiosurgery fails and surgical resection or re-radiosurgery is required. However, there has not been a comprehensive study focusing on the causes of secondary treatment for local recurrence or a new mass that develops outside the target area after radiosurgery. Hence, we analyzed the causes of radiosurgical failure in patients with meningioma. ⋯ We analyzed the causes of radiosurgical failure in meningioma patients and observed that microsurgery before radiosurgery was significantly associated with a high local recurrence rate compared with primary radiosurgery. Furthermore, the percentage of local recurrence cases that required secondary radiosurgery was as low as 2.98%. This result is comparable with that of microsurgical resection, which is the mainstay of treatment for meningioma.