Clinical neurology and neurosurgery
-
Clin Neurol Neurosurg · Oct 2015
Microsurgical efficacy and safety of a right-hemispheric approach for unruptured anterior communicating artery aneurysms.
We investigated the effectiveness of a right hemispheric surgical approach in treating unruptured anterior communicating artery aneurysms. ⋯ Microsurgical clipping of the unruptured Acom aneurysm through a right-side surgical approach showed favorable postoperative clinical and anatomical outcomes, especially aneurysms smaller than 10mm.
-
Clin Neurol Neurosurg · Oct 2015
Multicenter Study Clinical TrialPROSAIKA: a prospective multicenter registry with the first programmable gravitational device for hydrocephalus shunting.
Cerebrospinal fluid (CSF) overdrainage is a major problem in shunt therapy for hydrocephalus. The adjustable gravitational valve proSA allows for the first time a targeted compensation for overdrainage in the upright position without interfering with the differential pressure valve. To evaluate benefit, safety and reliability, the multicenter prospective registry PROSAIKA was conducted in 10 German neurosurgical centers. ⋯ This is the first clinical report on the implantation of the adjustable gravitational valve proSA with a follow-up of 12 months in a substantial number of patients. Irrespective of different hydrocephalus etiologies and indications for shunt surgery, the overall results after 12 months were very satisfying. The high frequency of valve readjustments underlines the fact that preoperative selection of the appropriate valve opening pressure is difficult. The low number of revisions and complications compared to other valves proves that proSA implantation adds no further risk; this valve is reliable, helpful and safe.
-
Clin Neurol Neurosurg · Oct 2015
The cost-effectiveness of surgery for trigeminal neuralgia in surgically naïve patients: a retrospective study.
For 75% of patients with trigeminal neuralgia (TN), the pain can be controlled with medication. For those who fail medication therapy, surgical options include microvascular decompression (MVD), percutaneous radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS). Few studies have explored the relative cost-effectiveness of these interventions, particularly in surgically naïve patients. ⋯ There are significant cost differences among the three most common surgical procedures for TN. MVD was the most expensive procedure, was more likely to be performed on younger patients, had the lowest rate of facial numbness, and had the lowest rate of recurrence requiring a secondary procedure. SRS was slightly less costly, more likely to be performed on an older population, and had a rate of recurrence similar to MVD. RFR was the least expensive procedure, provided immediate relief, but was associated with the highest rates of facial numbness and recurrence. Based on cost-effectiveness, considering both cost and outcome, RFR was the most cost-effective, followed by MVD, and finally SRS.
-
Clin Neurol Neurosurg · Oct 2015
Impact of percutaneous dilatational tracheostomy in brain injured patients.
Tracheostomy is an established method in the airway management of critically ill patients with traumatic and non-traumatic brain injuries. High priority in the treatment of those patients is to protect vulnerable brain tissue. While bedside percutaneously dilatative tracheostomy (PDT) technique is increasingly used, there is disagreement about the harms of this intervention for the damaged brain. Therefore, discussions about the safety of tracheostomy in those patients must consider direct and indirect cerebral parameters. ⋯ PDT is a safe procedure for the most common neurosurgical diseases, even for patients with respiratory insufficiency. Shortening surgical time seems to be the most important factor to avoid ICP increase.
-
Clin Neurol Neurosurg · Oct 2015
Treatment of selected syringomyelias with syringo-pleural shunt: the experience with a consecutive 26 cases.
It is well established that syringomyelia can cause neurological symptoms and deficit by accumulation of fluid within syrinx cavities that lead to internal compression within the spinal cord. When other intervention treating the underlying etiology failed to yield any improvement, the next option would be a procedure to divert the fluid from the syrinx cavity, such as syringo-subarachnoid, syringo-peritoneal or syringo-pleural shunting. The indications and long term efficacy of these direct shunting procedures are still questionable and controversial. ⋯ Collapse or remarkable shrinkage of the syrinx by SPS could ameliorate or at least stabilize the symptoms for the patient. We recommend small laminectomy and a less than 3mm myelotomy either at PML or DREZ. The SPS procedure can be an effective and relatively long-lived treatment for the idiopathic syringomyelia and those that failed other options.