Journal of neurosurgery
-
Journal of neurosurgery · Nov 2003
Randomized Controlled Trial Clinical TrialEvaluation of an antibiotic-impregnated shunt system for the treatment of hydrocephalus.
Staphylococcus species are the most common organisms responsible for infection following implantable cerebrospinal fluid (CSF) diversionary procedures. The role of an antibiotic-impregnated shunt (AIS) system in the prevention of shunt infection has remained unclear because no human clinical trial has been reported on thus far. In this study, the authors assess an AIS system with respect to its prevention of shunt infection. ⋯ The AIS afforded antistaphylococcal protection, especially during the early postoperative period when most shunt infections are known to occur and throughout the follow-up period (median 9 months). The AIS system represents another important tool to enable the neurosurgeon to prevent shunt infections.
-
Journal of neurosurgery · Nov 2003
Treatment of intracerebral hematomas caused by aneurysm rupture: coil placement followed by clot evacuation.
The aim of this study was to evaluate the efficacy of a treatment combination of coil embolization and clot evacuation in patients presenting with an intracerebral hematoma (ICH) caused by the rupture of an aneurysm. ⋯ The combined result of a favorable outcome in 48% of the patients and a mortality rate of 21% indicates that this treatment may be a valuable alternative for this patient group and warrants further study.
-
Journal of neurosurgery · Nov 2003
Surgery for Parkinson disease in the United States, 1996 to 2000: practice patterns, short-term outcomes, and hospital charges in a nationwide sample.
The surgical treatment of Parkinson disease (PD) has undergone a dramatic shift, from stereotactic ablative procedures toward deep brain stimulaion (DBS). The authors studied this process by investigating practice patterns, mortality and morbidity rates, and hospital charges as reflected in the records of a representative sample of US hospitals between 1996 and 2000. ⋯ Surgical treatment of PD in the US changed significantly between 1996 and 2000. Larger-volume hospitals had superior short-term outcomes and lower charges. Future studies should address long-term functional end points, cost/benefit comparisons, and inequities in access to care.
-
Journal of neurosurgery · Nov 2003
Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states.
The goal of this study was to determine whether a hospital's volume of subarachnoid hemorrhage (SAH) cases affects mortality rates in patients with SAH. For certain serious illnesses and surgical procedures, outcome has been associated with hospital case volume. Subarachnoid hemorrhage, usually resulting from a ruptured cerebral aneurysm, yields a high mortality rate. There has been no multistate study of a diverse set of hospitals to determine whether in-hospital mortality rates are influenced by hospital volume of SAH cases. ⋯ Patients with a diagnosis of SAH on their discharge records who initially presented through the emergency department of a hospital with a high volume of SAH cases had significantly lower mortality rates. Concentrating care for this disease in high-volume SAH treatment centers may improve overall survival.
-
Journal of neurosurgery · Nov 2003
Case ReportsAssociation between a black band on the inner membrane of a chronic subdural hematoma on T2*-weighted magnetic resonance images and enlargement of the hematoma.
The cause and indication for enlargement of chronic subdural hematomas (CSDHs) have remained unresolved. The authors observed a black band on the inner membrane of a CSDH on T2*-weighted magnetic resonance (MR) images obtained in patients with symptoms. After surgical treatment, the band disappeared. The T2*-weighted sequence of MR imaging is an excellent diagnostic tool for detecting ferromagnetic substances, but it is rarely performed in cases of a CSDH. The authors speculate that the black band may be associated with the development of CSDH. ⋯ The dynamics of the black band may depend on the enlargement or shrinkage of the CSDH.