Neurosurgery
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Intraventricular (IVen) hemorrhage is considered a predictor of poor outcome after subarachnoid hemorrhage (SAH). This prospective study examines the feasibility and outcome of administration of IVen tissue plasminogen activator (tPA) after aneurysmal SAH. ⋯ This pilot study shows that IVen tPA administration is feasible without complications after SAH and may be associated with better outcomes. These results warrant a randomized clinical trial.
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The new Accreditation Council for Graduate Medical Education (ACGME) requirements regarding resident work hours have been implemented since July 2003. Neurological surgery training programs have been especially affected because of the limited number of residency positions and the residents' long duty hours. The perceptions of program directors and residents may provide important insight into the evolution of new guidelines for improvement of resident training. ⋯ On the basis of their early experience, the majority of the residents and program directors think that the ACGME duty hour guidelines have had an adverse effect on continuity of patient care and resident training. The effects of these guidelines on neurosurgery programs should be carefully monitored, because more sophisticated solutions may be needed to address house staff fatigue. Strategies to enhance the educational content of the residents' work hours and to preserve continuity of patient care are necessary.
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We evaluated whether serum levels of neuron-specific enolase (NSE) and S-100beta protein are biomarkers for traumatic injury in an animal model of spinal cord injury (SCI). ⋯ Present data suggest that NSE and S-100beta serum levels may be useful experimental tools for the acute measurement of tissue loss after SCI. Despite significant shortcomings, NSE and S-100beta serum measurements in acute SCI patients with clinically defined functional deficits should allow comparisons with well-characterized SCI animal models. Future efforts to develop biomarkers that predict functional outcomes in the acute phase should focus on axon-specific proteins as markers of secondary axonal loss and regeneration.
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To evaluate the safety, efficacy, and utility of a novel surgical strategy consisting of multiple (more than two) operative stages performed during the same hospital admission with subdural grid and strip electrodes in selected pediatric extratemporal epilepsy. ⋯ In a very select group of pediatric patients with poor surgical prognostic factors, the multistage approach can be beneficial. After failed epilepsy surgery, subsequent reoperation with additional intracranial investigation traditionally is used when a single residual focus is suspected. Our results, however, support the contention that multistage epilepsy surgery is safe, effective, and useful in a challenging and select pediatric population with extratemporal medically refractory epilepsy.
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For more than a decade, motor cortex stimulation has been used to treat difficult central and peripheral neuropathic pain syndromes. This prospective study uses the McGill Pain Questionnaire, a visual analog scale (VAS) score, and an inventory of drug consumption to review the results of treating patients with trigeminal neuropathic pain via motor cortex stimulation. ⋯ These results provide further support for the use of motor cortex stimulation in facial neuropathic pain and document pain improvement as measured by multidimensional scales. Observations of motor and sensory improvements during stimulation suggest that stimulation alters cortical plasticity and inhibits thalamic hyperactivity.