Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · May 2016
The incidence of dural tears after complete resection of lumbar synovial cysts and the relation to the outcome.
Synovial cysts in the lumbar spine are uncommon causes of radicular pain. In cases where conservative treatment fails, surgical resection is recommended. Dural adhesions are common intraoperative findings; therefore, the removal of the cyst may sometimes result in dural tears. The frequency of dural tears is greater with synovial cysts than in other lumbar surgeries. Clinical parameters and characteristics seen on magnetic resonance imaging were assessed to investigate the correlation between the outcome after surgery of lumbar synovial cysts and dural tears. ⋯ Dural tears were found significantly more often in patients without a good outcome; they appear to portend a poorer prognosis. The level L5/S1 was significantly more often affected. During surgery, it should be considered whether to remove the cyst completely and risk a dural tear, or to leave residuals of the cyst wall if otherwise a good decompression is achieved.
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Clin Neurol Neurosurg · May 2016
Multicenter Study Observational StudyPredictors of good functional outcomes and mortality in patients with severe rebleeding after aneurysmal subarachnoid hemorrhage.
Aneurysmal rebleeding is a major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH); however, limited data on severity of rebleeding and outcomes after severe rebleeding are available. We aimed to determine predictors of good outcome and mortality after severe rebleeding. ⋯ A better clinical condition after rebleeding were independently associated with good outcome and inversely associated with morality after severe rebleeding. Despite high mortality of rebleeding, patients with WFNS grade IV treated with aggressive treatment were more likely to have good outcomes regardless of their condition before rebleeding.
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Clin Neurol Neurosurg · May 2016
Meta AnalysisPrevalence of the accessory deep peroneal nerve: A cadaveric study and meta-analysis.
The accessory deep peroneal nerve (ADPN) is a common anatomical variant arising from the superficial peroneal nerve (SPN) and, when present, is often responsible for partial or complete innervation of the extensor digitorum brevis muscle (EDBM). The nerve lies posterior to the peroneus brevis muscle, traveling posterior to the lateral malleolus to terminate in the ankle by giving off sensory branches to the ankle and joints. Although the EDBM is usually supplied by the deep peroneal nerve (DPN), in the presence of an ADPN, electrodiagnostic procedures may be complicated. Due to the lack of detailed anatomical knowledge on the topography of the ADPN, its presence posterior to the lateral malleolus can be iatrogenically injured during surgical procedures on the ankle using a lateral approach. Therefore, this meta-analysis aimed to provide a comprehensive, evidence-based assessment of the anatomical characteristics of the ADPN, supplemented with data from our own cadaveric dissection. ⋯ The ADPN is a clinically important nerve and has been inculpated in unexplained cases of chronic ankle pain and EDBM atrophy. The variability in detection of the ADPN using electrophysiological techniques can lead to misdiagnoses of peroneal nerve lesions and increase the risk for iatrogenic injury to the ADPN, especially in laterally approaching ankle procedures and sural nerve biopsies.
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Clin Neurol Neurosurg · May 2016
Randomized Controlled Trial Comparative StudyComparative analysis of clinical outcomes between zero-profile implant and cages with plate fixation in treating multilevel cervical spondilotic myelopathy: A three-year follow-up.
This study aimed to figure out three-year clinical outcomes and complications of ACDF with Zero-p in treating multilevel cervical spondylotic myelopathy (MCSM) by comparing with plate fixation. ⋯ Based on the three-year follow-up, we could not conclude that Zero-P was superior to plate fixation in clinical outcomes such as neurological results, cervical lordosis, fusion rate and the incidence and severity of dysphagia in treating MCSM. However, it had the advantage of reducing ALOD incidence which tended to happen in ACDF with plate fixation.
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Clin Neurol Neurosurg · May 2016
Acute effects of intraventricular nicardipine on cerebral hemodynamics: A preliminary finding.
Intraventricular nicardipine (IVTN) is a treatment option for severe vasospasm in patients with subarachnoid hemorrhage (SAH). However, its acute effects on cerebral hemodynamics have not been studied in detail. ⋯ The vasodilatory effect of IVTN transiently increased ICP, but did not significantly affect PbtO2, CBF or oxidative glucose metabolism in the immediate phase after injection.