Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Apr 2014
Use of thrombin-based hemostatic matrix during meningioma resection: a potential risk factor for perioperative thromboembolic events.
Hemostatic agents are widely used in patients undergoing intracranial tumor resection to facilitate local hemostasis. We hypothesized that systemic activation of the clotting cascade after local application of hemostatic agents may result in unintended thromboembolic events, including deep venous thrombosis (DVT) and pulmonary embolism (PE). We performed a retrospective analysis to identify potential associations between hemostatic agent use and DVT/PE. ⋯ Hemostatic agents are valuable tools in modern neurosurgery, however their use may be associated with an increased risk of DVT/PE in patients undergoing meningioma resection. This finding provides the impetus for more definitive clinical and laboratory studies to characterize the biology of this association and helps identify patients at increased risk for thromboembolism. This study also affirms the association between high BMI and the risk of thromboembolism. Interestingly the use of prophylactic anticoagulation after surgery did not decrease the incidence of DVT/PE.
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Clin Neurol Neurosurg · Apr 2014
Results and risk factors for recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenoma.
Endoscopic endonasal (EE) transsphenoidal surgery is an important surgical approach to the treatment of sellar pathology, particularly for pituitary adenomas. Risk factors for the radiographic recurrence of pituitary adenomas resected using a purely endoscopic approach have not been established. This study investigates outcomes and identifies risk factors for recurrence following EE transsphenoidal surgery for pituitary adenoma. ⋯ Only 20% of patients with residual tumor developed recurrent disease over a median follow up of 23.1 months. This recurrence rate may be an important consideration in cases where gross total resection is not feasible. Preferentially operating from the right does not seem to influence the location of residual tumor.
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Clin Neurol Neurosurg · Apr 2014
Marking wire placement for improved accuracy in thoracic spinal surgery.
To present an innovative approach that does not rely on intraoperative X-ray imaging for identifying thoracic target levels and critically appraise its value in reducing the risk of wrong-level surgery and radiation exposure. ⋯ This is a safe and practical approach to identify the level of interest in thoracic spinal surgery employing a marking wire. Its application merits consideration in any spinal case where X-ray localization could prove unsafe, particularly in cases lacking bony pathologies such as intradural tumors.
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Clin Neurol Neurosurg · Apr 2014
Clinical REM sleep behavior disorder and motor subtypes in Parkinson's disease: a questionnaire-based study.
Studies documenting the association between rapid eye movement sleep behavior disorder (RBD) and motor subtypes in Parkinson's disease (PD) are rare. Our hypothesis is that RBD may be more severe in non-tremor dominant (NTD) patients with RBD than those tremor dominant (TD) with RBD. In this study, we investigated the association between motor subtypes and clinical RBD in PD. ⋯ In our study, frequency of clinical RBD was unrelated to motor subtypes of PD. However, in the present study, we found a weak correlation between clinical severity (UPDRS and the Hoehn-Yahr) of PD and severity of clinical RBD in the NTD subtype but not in the TD subtype.
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Clin Neurol Neurosurg · Apr 2014
Long-term follow-up of bilateral anterior capsulotomy in patients with refractory obsessive-compulsive disorder.
Obsessive-compulsive disease (OCD) is a severe psychiatric disorder suffers tens of millions of people around the world. There are many treatment options available, however, still nearly 40% of OCD patients do not respond very well to the therapeutic methods. For treatment-refractory OCD patients, bilateral anterior capsulotomy is a potential therapy. ⋯ Our study indicates that bilateral capsulotomy is a precise and relatively safe therapy for refractory OCD, which can improve patients' quality of life and restores their social function. There must be strict inclusion criteria for patients considering of the complications and the irreversibility of this procedure.