Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Apr 2016
Thirty day postoperative outcomes following anterior lumbar interbody fusion using the national surgical quality improvement program database.
Anterior lumbar interbody fusion (ALIF) is a common procedure used to treat various lumbar degenerative pathologies. The purpose of this study is to describe 30-day postoperative outcomes following ALIF on a national scale. ⋯ Diverse postoperative complications need to be managed following ALIF. Patients with spondylolisthesis and spinal stenosis may carry increased 30-day postoperative morbidity profiles in ALIF when compared to those with degenerative disc disease. Prospective studies are needed to better delineate the outcomes of ALIF procedures, particularly in the spondylolisthesis and spinal stenosis patient populations.
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Clin Neurol Neurosurg · Apr 2016
Comparative StudyThe effect of anterior projection of aneurysm dome on the rupture of anterior communicating artery aneurysms compared with posterior projection.
Recent studies have shown that anterior projection aneurysms are associated with increased risk of rupture of anterior communicating artery (ACoA) aneurysms. We aimed to determine differences in patient characteristics and aneurysm morphologies between the anterior projection and posterior projection aneurysm groups and to determine morphological predictors of rupture of the anterior projection aneurysms. ⋯ Compared with posterior projection aneurysms, the anterior projection aneurysms have a higher risk of rupture probably because of significant differences in aneurysm morphologies. A larger size ratio and a smaller vessel size may be helpful to predict the risk of rupture in the anterior projection aneurysms.
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Clin Neurol Neurosurg · Apr 2016
The value of dynamic radiographic myelography in addition to magnetic resonance imaging in detection lumbar spinal canal stenosis: A prospective study.
MRI is regarded as the study of choice in the diagnosis of lumbar spinal stenosis. In some cases, the supine MRI leads to a misdiagnosis in the extent of lumbar spinal stenosis. Dynamic myelography can detect lumbar spinal stenosis in these cases of where the MRI may not be as sensitive. To compare the sensitivities of dynamic radiographic myelography and supine MRI in lumbar canal stenosis (LCS) patients and to determine whether dynamic radiographic myelography is a valuable diagnostic exam in the work-up of lumbar canal stenosis. ⋯ n Based on a large patient sample, dynamic myelography is a valuable diagnostic tool in detecting lumbar spinal stenosis. Patients with lumbar spinal stenosis may have inconclusive supine MRI in 23% of cases being misdiagnosed as normal. This missed rate of LCS patients with unclear supine MRI results can be avoided with dynamic myelography. The combination of supine MRI and dynamic myelography is critical in the evaluation of LCS, especially if multisegmental findings are detected.
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Clin Neurol Neurosurg · Apr 2016
Pre-operative and post-operative cognitive deficits in patients with supratentorial meningiomas.
Cognitive deficits caused by extra-axial benign brain tumors like meningiomas and the course of these deficits after surgery is not well known. The aim of the study is to assess the pre-operative and post-operative cognitive functions in patients with meningiomas in the supratentorial compartment. ⋯ Meningiomas cause cognitive deficits in 73.7% of patients. Anatomical location of meningioma, elevated ICP, the volume of meningioma and extent of peritumoral edema significantly influence the incidence of cognitive deficits. Post-operatively, the cognitive deficits improve significantly in the frontal and temporal group.
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Clin Neurol Neurosurg · Apr 2016
Microelectrode recording (MER) findings during sleep-awake anesthesia using dexmedetomidine in deep brain stimulation surgery for Parkinson's disease.
The preferred choice of anesthesia for deep brain stimulation (DBS) has been local anesthesia due to the need of patients' cooperation during the procedure, and concern on the interference of sedatives on microelectrode recording (MER) results. However, local anesthesia during the whole procedure may be impossible in some patients due to uncontrolled anxiety, fear, delirium or exhaustion. Therefore, sedative drugs have been used for DBS, but findings of MER during the procedures have not been reported in detail, especially in the globus pallidus internus (GPi). We introduce our experience using 'asleep-awake' technique by dexmedetomidine (DEX) anesthesia with MER findings during DBS in idiopathic Parkinson's disease (IPD) patients. ⋯ We concluded that though MER findings may change during DEX-based monitored 'sleep-awake' anesthesia, it did not affect the results of target localization for the clinical purpose. However, it should be considered that use of sedatives before MER could result in changes of firing rate and pattern depending on the patient's state of consciousness.