Journal of neurosurgery
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Journal of neurosurgery · Jun 2011
Clinical significance of positive cranial bone flap cultures and associated risk of surgical site infection after craniotomies or craniectomies.
The risk of surgical site infection (SSI) after craniotomies or craniectomies in patients in whom contaminated bone flaps have been reimplanted has not been determined. The objectives of this study were to identify the prevalence of bone flaps with positive cultures--especially those contaminated with Propionibacterium acnes--to assess the risk of SSI after reimplanting (either during the initial operation or subsequently) bone flaps with positive cultures, and to identify risk factors for SSI following the initial craniotomies or craniectomies. ⋯ Operative factors such as the way the skin is prepared before the incision rather than the skin flora contaminants on the bone flaps may play an important role in the pathogenesis of SSIs after craniotomy/craniectomy. Gliadel wafers significantly increased the risk of SSI after procedures to treat tumors.
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Journal of neurosurgery · Jun 2011
Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients.
The development of endoscopic endonasal approaches, albeit in the early stages, represents part of the continuous evolution of skull base surgery. During this early period, it is important to determine the safety of these approaches by analyzing surgical complications to identify and eliminate their causes. ⋯ Endoscopic endonasal skull base surgery provides a viable median corridor based on anatomical landmarks and is customized according to the specific pathological process. This corridor should be considered as the sole access or may be combined with traditional approaches. With the incremental acquisition of skills and experience, endoscopic endonasal approaches have an acceptable safety profile in select patients presenting with various skull base pathologies.
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Journal of neurosurgery · Jun 2011
Quality of life in patients with intracranial gliomas: the impact of modern image-guided surgery.
Outcome following brain tumor operations is often assessed by health professionals using various gross function scales. However, surprisingly little is known about how modern glioma surgery affects quality of life (QOL) as reported by the patients themselves. In the present study the authors aimed to assess changes in QOL after glioma surgery, to explore the relationship between QOL and traditional outcome parameters, and to examine possible predictors of change in QOL. ⋯ The surgical procedures per se may not significantly alter QOL in the average patient with glioma; however, new deficits have a major undesirable effect on QOL. It seems that the active use of intraoperative ultrasonography may be associated with a preservation of QOL. The EQ-5D seems like a good outcome measure with a strong correlation to traditional variables while offering a more detailed description of outcome.
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Journal of neurosurgery · Jun 2011
Neurological outcome in patients with traumatic brain injury and its relationship with computed tomography patterns of traumatic subarachnoid hemorrhage.
Traumatic subarachnoid hemorrhage (SAH) is a poor prognostic factor for traumatic brain injury. The authors aimed to further investigate neurological outcome among head injury patients by examining the prognostic values of CT patterns of traumatic SAH, in particular, the thickness and distribution. ⋯ Maximum thickness of traumatic SAH was a strong independent prognostic factor for death and clinical outcome. Anatomical distribution per se did not affect clinical outcome.
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Journal of neurosurgery · Jun 2011
Biography Historical ArticleCushing and the treatment of brain wounds during World War I.
Harvey Cushing, perhaps the most important founder of American neurosurgery, was an Army neurosurgeon in France from 1917 to 1918. Over a 3-month period in 1917 he and his team operated on 133 soldiers with a brain wound. The operative mortality rate for their last 45 patients was 29%, considerably lower than the usual postoperative mortality rate of approximately 50% for those with a brain wound. ⋯ As the decades passed he was eventually credited as the "originator of brain wound care." This report shows that these attributions are misplaced. Cushing merely followed the enlightened surgical precepts of the time developed by Continental (European) surgeons. It also examines Cushing's writings to ascertain how these misperceptions concerning his originality might have been generated.