Journal of neurosurgery
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Journal of neurosurgery · Jan 2018
CT-guided selective percutaneous radiofrequency thermocoagulation via the foramen rotundum for isolated maxillary nerve idiopathic trigeminal neuralgia.
OBJECTIVE Although CT-guided selective percutaneous radiofrequency thermocoagulation (PRFT) via the foramen rotundum (FR) has been used in the clinic as a novel successful treatment for isolated, second division (maxillary nerve [V2]), idiopathic trigeminal neuralgia (ITN), there is only very limited related literature published to date. This report aims to provide more detail for physicians about this technique. METHODS Between March 2013 and April 2014, 20 patients with isolated V2 ITN refractory to or intolerant of drug treatment were treated by CT-guided selective PRFT via the FR at the First Affiliated Hospital of Nanchang University. ⋯ No adverse effects or complications occurred except for transient numbness restricted to the V2 dermatome in all patients (100%) and facial hematoma in 3 patients (15%). CONCLUSIONS In the current study, CT-guided selective PRFT via the FR not only achieved absolute selective lesioning to V2, but also helped patients attain successful pain relief with few adverse effects. These limited data suggest that CT-guided selective PRFT via the FR appears to be a feasible, safe, effective, and even relatively ideal treatment for isolated V2 ITN, but these findings need confirmation from further studies.
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Journal of neurosurgery · Jan 2018
Development of a prediction rule for diagnosing postoperative meningitis: a cross-sectional study.
OBJECTIVE Diagnosing nosocomial meningitis (NM) in neurosurgical patients is difficult. The standard CSF test is not optimal and when it is obtained, CSF cultures are negative in as many as 70% of cases. The goal of this study was to develop a diagnostic prediction rule for postoperative meningitis using a combination of clinical, laboratory, and CSF variables, as well as risk factors (RFs) for CNS infection. ⋯ CONCLUSIONS The prediction rule for diagnosing NM improves the diagnostic accuracy in neurosurgical patients with suspicion of infection. A score ≥ 6 points suggests a high probability of neuroinfection, for which antibiotic treatment should be considered. An independent validation of the rule in a different group of patients is warranted.
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Journal of neurosurgery · Jan 2018
The value of endoscope assistance during transcranial surgery for tuberculum sellae meningiomas.
OBJECTIVE In tuberculum sellae meningioma (TSM) surgery, endonasal approaches are claimed to have a superior visual outcome compared with transcranial approaches. The authors question whether this is always true and analyze their series of cases of endoscope-assisted transcranial TSM surgery with special regard to the postoperative visual outcome in order to explore this issue. METHODS All surgical procedures for TSM performed between 2003 and 2015 in the Department of Neurosurgery, University Medicine Greifswald, were retrospectively analyzed. ⋯ The use of the endoscope as an assistive device led to improved tumor visualization and consequent removal in areas that were hidden in the microscopic view in 6 patients (40%). CONCLUSIONS The present series confirms a favorable visual outcome after TSM surgery via supraorbital or frontolateral endoscope-assisted approaches. With endoscopic visualization, major manipulation of the optic apparatus could be avoided, perhaps affecting the favorable visual outcome.
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Journal of neurosurgery · Jan 2018
A novel method of lengthening the accessory nerve for direct coaptation during nerve repair and nerve transfer procedures.
OBJECTIVE The accessory nerve is frequently repaired or used for nerve transfer. The length of accessory nerve available is often insufficient or marginal (under tension) for allowing direct coaptation during nerve repair or nerve transfer (neurotization), necessitating an interpositional graft. An attractive maneuver would facilitate lengthening of the accessory nerve for direct coaptation. ⋯ The additional length of accessory nerve even allowed direct repair of an infraclavicular target (i.e., the proximal musculocutaneous nerve). The cervical nerve connections were shown not to contain motor fibers. CONCLUSIONS An additional length of the accessory nerve made available in the posterior cervical triangle can facilitate direct repair or neurotization procedures, thus eliminating the need for an interpositional nerve graft, decreasing the time/distance for regeneration and potentially improving clinical outcomes.
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Journal of neurosurgery · Jan 2018
Present epidemiology of chronic subdural hematoma in Japan: analysis of 63,358 cases recorded in a national administrative database.
OBJECTIVE Aging of the population may lead to epidemiological changes with respect to chronic subdural hematoma (CSDH). The objectives of this study were to elucidate the current epidemiology and changing trends of CSDH in Japan. The authors analyzed patient information based on reports using a Japanese administrative database associated with the diagnosis procedure combination (DPC) system. ⋯ CONCLUSIONS This study shows a chronological change in the age distribution of CSDH among Japanese patients, which may be affecting the prognosis of this condition. In the aging population of contemporary Japan, patients in their 80s were affected more often than patients in other age categories, and approximately 30% of patients with CSDH required some help at discharge. CSDH thus may no longer have as good a prognosis as had been thought.