Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Oct 2015
Long-term follow-up study of 35 cases after endovascular treatment for vertebrobasilar dissecting aneurysms.
Vertebrobasilar dissecting aneurysm (VBDA) management is challenging despite the availability of multiple treatment strategies. We reviewed our experiences using endovascular treatment for VBDA patients to assess the efficacy and safety of several VBDA treatment strategies. ⋯ For patients with ruptured VBDAs, the complication rate associated with endovascular treatment is acceptable. CE+PT is better than stent coiling in preventing aneurysmal rerupture, but is associated with a high incidence of ischemic stroke. For unruptured VBDAs, endovascular treatment is associated with good clinical outcome without perioperative complications, including rerupture and ischemic stroke. However, the high postoperative recurrent aneurysm risk suggests the necessity of long-term angiographic follow-up monitoring of VBDA patients who undergo endovascular treatments.
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Clin Neurol Neurosurg · Oct 2015
Aspirin Response Test role in platelet transfusion following intracerebral hemorrhage.
Spontaneous intracerebral hemorrhage (ICH) results in high morbidity and mortality. A target for therapy might be hematoma expansion, which occurs in a significant proportion of patients, and can be exacerbated by antiplatelet medications, such as aspirin. It is not clear whether platelet transfusion neutralizes aspirin. The Aspirin Response Test (ART) is commonly ordered in this patient population, but it is not clear whether the results of this test can help select patients for transfusion of platelets. The aim of our study is to investigate whether a selected group of ICH patients, those with reduced platelet activity ("aspirin responders"), will benefit from platelet transfusion. ⋯ Our data suggest that platelet transfusion following an ICH in "aspirin responders" does not reduce hematoma expansion rates in those patients. A larger prospective study is needed.
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Clin Neurol Neurosurg · Sep 2015
Rivaroxaban and intracranial haemorrhage after mild traumatic brain injury: A dangerous combination?
Despite several advantages of the novel anticoagulant rivaroxaban compared with vitamin K antagonists (VKA), its lack of specific antidotes to reverse anticoagulant effects may increase the risk profile of patients with bleeding complications. The purpose of this study was to analyze the effects of pre-injury treatment with rivaroxaban on patients with mild traumatic brain injury (TBI) and traumatic intracranial haemorrhage (tICH). ⋯ Despite major limitations of retrospective design and small patient numbers, our results suggest that rivaroxaban may exacerbate intracranial haemorrhage in patients with mild TBI. Further studies are needed to characterize the risk profile of this drug in patients with tICH.
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Clin Neurol Neurosurg · Sep 2015
Extradural transcavernous approach to cavernous sinus cavernous hemangiomas.
Cavernous sinus cavernous hemangioma (CSCH) is a rare extra-axial vascular lesion and is difficult to be removed due to their location, propensity for profuse bleeding during surgery, and relationship to complex neurovascular structures. The purpose of this study is to report our experience of the removal of CSCHs through a completely extradural transcavernous approach. ⋯ CSCHs are rare and challenging skull base tumors. The microsurgical resection, using an extradural transcavernous approach which allows complete tumor resection with an acceptable intraoperative and postoperative complications, should be considered as a favorable choice among all treatments.
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Clin Neurol Neurosurg · Sep 2015
Incomplete resection of lumbar synovial cysts – Evaluating the risk of recurrence.
Synovial cysts are generally located in the lumbar spine adjacent to facet joints. Most studies recommend surgical resection. Adhesions of the lumbar synovial cyst to the dura are common and can result in dural tears with subsequent CSF fistula or nerve injury. The recurrence rate after incomplete resection of lumbar synovial cysts is unclear. For this purpose, we report on our experience of 148 patients who underwent synovial cyst resection from 2000 to 2011. ⋯ Only in case of severe adhesions to the dura complete resection was not enforced to avoid dural tears. In none of the 8 patients symptomatic recurrence of synovial cysts occurred. Aware of the limited numbers, we suggest rather leaving remnants of an attached synovial cyst behind after a sufficient decompression than risking dural tears and surgery-related complications. This trial is registered with DRKS00006133.