Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Sep 2014
Visualization of small veins with susceptibility-weighted imaging for stereotactic trajectory planning in deep brain stimulation.
Intracerebral hemorrhage (ICH) is the most significant complication of Deep Brain Stimulation (DBS). To prevent ICH, stereotactic contrast enhanced T1-weighted images are used to visualize vessels as source of hemorrhage. Susceptibility-Weighted Imaging (SWI) is an MRI sequence with improved visualization of susceptibility differences between tissues, particularly sensitive for brain veins. ⋯ SWI facilitates the visualization of small veins superior to T1-weighted images. However, cerebral veins within the trajectory were not found to be a significant source of ICH after DBS. Potential sources of ICH are mesencephal veins at the endpoint of electrodes which can cause fatal hemorrhage and are visualized with SWI reliably.
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Clin Neurol Neurosurg · Sep 2014
Case ReportsSurgical outcomes after classifying Grade III arteriovenous malformations according to Lawton's modified Spetzler-Martin grading system.
We aimed to evaluate microsurgical outcomes after classifying Grade III arteriovenous malformations (AVMs) according to Lawton's modified Spetzler-Martin grading system. ⋯ The modified classification of Grade III AVMs was useful to predict surgical morbidity and clinical outcomes. We recommend that microsurgery should be used to treat Grade III- AVMs, but should be considered carefully for the treatment of Grades III and III+.
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Clin Neurol Neurosurg · Aug 2014
ReviewChemoprophylaxis for venous thromboembolism in traumatic brain injury: a review and evidence-based protocol.
Venous thromboembolism (VTE) is a recognized source of morbidity and mortality in patients suffering traumatic brain injury (TBI). While traumatic brain injury is a recognized risk factor for the development of VTE, its presence complicates the decision to begin anticoagulation due to fear of exacerbating the intracranial hemorrhagic injury. ⋯ The review reveals robust evidence regarding the safety and efficacy of chemoprophylaxis in the setting of TBI following demonstration of a stable intracranial injury. In light of this data, a protocol is assembled that, in the absence of predetermined exclusion criteria, will initiate chemoprophylaxis within 24h after the demonstration of a stable intracranial injury by computed tomography (CT).
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Clin Neurol Neurosurg · Aug 2014
Longitudinal incidence and concurrence rates for traumatic brain injury and spine injury - a twenty year analysis.
The reported incidence of concurrent traumatic brain (TBI) and spine or spinal cord injuries (SCI) is poorly defined, with widely variable literature rates from 16 to 74%. ⋯ A retrospective review of the NIS demonstrates a rising trend in the incidence of concurrent TBI and SCI. More investigative work is necessary to examine causative factors for this trend.